The Centers for Medicare & Medicaid Services (CMS) has restructured the Medicare Quality Improvement (QIO) Program by splitting it into two parts and creating two different types of QIOs. The first, called Beneficiary and Family Centered Care QIOs (BFCC-QIO), will handle all of the case reviews, appeals and quality of care concerns. The second, called QIO Quality Innovation Networks (QIO-QIN), will work with providers and the community on health care quality improvement work. CMS will not allow one entity to be both a BFCC-QIO and a QIO-QIN.
As of Aug. 1, 2014, KePRO will be the new BFCC-QIO for Arkansas' Medicare beneficiaries and will be responsible for conducting quality of care reviews, discharge and termination of service appeals, and other areas of required review in various provider settings.
Health care providers and Medicare beneficiaries must contact KePRO toll-free at 1-844-430-9504 for all appeal requests and quality of care concerns. All outstanding higher-weighted DRG medical record requests after the above date should be mailed to:
Rock Run Center
5700 Lombardo Center, Suite 100
Seven Hills, Ohio 44131
AFMC elected to focus on the QIN-QIO work in Arkansas as part of a multistate, regional consortium headed by the TMF Health Quality Institute of Austin, Texas. We look forward to continuing to work side-by-side with providers in Arkansas on quality improvement initiatives, health information technology, patient-centered engagements, and myriad other health care improvement initiatives as we continue our mission to promote excellence in health and health care through education and evaluation.