The Quality Improvement Organization (QIO) Program originated with the Peer Review Improvement Act of 1982 and is authorized by Title XI Part B and Title XVIII the Act. The goal of the QIO program is to improve the quality of care for Medicare beneficiaries, including beneficiary complaints, skilled service termination appeals, and Immediate Advocacy to protect the Medicare Trust Fund. The QIO program is to achieve this goal through performance of various case review directives promulgated by CMS in the QIO Contract
As of June 8th, there are important updates that apply to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QI) in Indiana and Kentucky. Providers should review documents and publications noted below with references to KEPRO. The following actions should take place:
Indiana:
- Remove KEPRO (effective June 8, 2019) and replace with Livanta information (https://www.livantaqio.com)
- Update Medicare Beneficiary Notices with Livanta’s helpline information effective June 8, 2019
- Indiana is in Region 5 (OH, IN, IL, MI, MN, WI): 888-524-9900
Kentucky:
- KEPRO was awarded for the next contract period with CMS for Kentucky (https://www.keproqio.com/)
- As of June 8th, KEPRO’s helpline numbers were changed. Update notices with correct phone number to ensure beneficiaries are able to make timely appeals.
- Kentucky is in Region 4 (AL, FL, FA, KY, MS, NC, SC, TN): 888-317-0751
Affected SNF Notices:
- Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123) (Click here to download)
- Detailed Explanation of Non-Coverage (DENC, Form CMS-10124) (Click here to download)
Resources:
- Updated BFCC-QIO Directory for all 10 Regions (Click here)
- CMS BNI website (Click here)
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Blog by Stacy Baker, OTR/L, RAC-CT, CHC, Director of Audit Services, Proactive Medical Review
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