Changes in Quality of Care review process

Posted on: 3/1/17


The Centers for Medicare & Medicaid Services (CMS) recently revised Chapter 5 of the Quality Improvement Organization (QIO) Manual, related to changes to the Quality of Care review process, effective Feb. 1, 2017. The changes include:
  • Providers now have 14 calendar days (they were previously allowed 30 days) to send in the medical record once a medical record request is received. Because of these tightened time frames, KEPRO encourages providers to fax medical records rather than sending them via mail. The Quality of Care department at KEPRO has its own dedicated fax number, which will be listed on the medical record request.
  • After the medical records are received, KEPRO has 30 days to complete the review. Providers that wish to provide a response when they receive an inquiry from KEPRO will also have a shortened time frame, which will be noted on the inquiry letter.
  • Medicare beneficiaries, or their representatives, have the opportunity to request a second review if they disagree with the original findings, similar to the current process in place for providers.
KEPRO, the quality of care review organization for Oklahoma is offering a webinar on March 30 to assist hospitals in understanding the new changes. To register for the webinar, click here and look for KEPRO - the BFCC-QIO on March 30.  

For more information, click here. (LaWanna Halstead)

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