This contract enables us to facilitate key improvements in QIO case review and beneficiary care complaint processes, as well as to identify best practices related to system-wide quality improvement nationally.
Harrisburg, PA (Vocus) August 13, 2009
Ohio KePRO, the Quality Improvement Organization (QIO) for the state of Ohio, was named as the Medicare Beneficiary Protection Program Support Contractor by the Centers for Medicare & Medicaid Services (CMS). Ohio KePRO, a subsidiary of KePRO, a national quality improvement and integrated care management company, will provide support to all QIOs in beneficiary protection activities to enhance the program's effectiveness and facilitate quality improvement. The contract began immediately upon award, and runs through July 31, 2011.
"For the past ten years, Ohio KePRO has successfully worked to protect the rights and to help improve the quality of health care for Ohio's 1.8 million Medicare beneficiaries," said Joe Dougher, KePRO's Chief Executive Officer. "This contract enables us to facilitate key improvements in QIO case review and beneficiary care complaint processes, as well as to identify best practices related to system-wide quality improvement nationally."
QIOs are mandated by CMS to perform utilization review, quality of care review, review of beneficiary appeals of certain provider notices and review of potential anti-dumping cases. Quality of care review includes the review of beneficiary complaints. Ohio KePRO will work with all QIOs to ensure that review and beneficiary complaint processes are performed efficiently and effectively, to survey beneficiary satisfaction with complaint processes and outcomes, and to promote the use of alternative dispute resolution mechanisms, when appropriate. Ohio KePRO will also work to enhance QIO collaboration with other Medicare contractors and the Office of Inspector General to clearly establish the link between case review and quality.
Ohio KePRO's work to protect Medicare beneficiaries was featured in the Cleveland Plain Dealer on Tuesday, August 4, 2009. The article, Medicare provides for independent review of discharge decisions, explains that Medicare beneficiaries have the right to request a review when they feel they are being discharged from the hospital or home health care too soon.
About Ohio KePRO:
Ohio KePRO, a subsidiary of KePRO, is celebrating its 10th anniversary as the Quality Improvement Organization (QIO) for the state, under contract to the Centers for Medicare & Medicaid Services (CMS). Ohio KePRO is committed to continuous quality improvement in health care through the provision of innovative products and services at no charge to health care providers or Ohio's 1.8 million Medicare beneficiaries. Ohio KePRO works toward the CMS goal of the right care for every person, every time by providing quality improvement and medical case review services to protect beneficiaries and the Medicare Trust Fund.
Ohio KePRO quality improvement specialists collaborate with health care providers and stakeholders statewide to foster improved quality and care efficiency through consultation services, training, and other resources. The health of Ohioans has improved in these areas in recent years, with an increase in statewide rates of preventive services and a decrease in related mortality rates for breast and colorectal cancer, flu, and pneumonia.
Ohio KePRO also reviews medical cases as requested by Medicare beneficiaries, Medicare, or designated hospital staff members. These case reviews include beneficiary complaints, coverage and discharge appeals, hospital admissions, continued stays, and quality of care concerns. For more information, visit http://www.ohiokepro.com.
KePRO, a leading quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize quality of care for public and commercial clients. KePRO's comprehensive, member centric care management solutions go far beyond traditional utilization and case management by coordinating the care provided to members with acute, chronic and complex conditions across the continuum, and identifying members who are at the highest risk for future services, but have not yet had an acute event. Tailored programs maximize members' quality of life, and realize greater cost savings for members and clients.
Headquartered in Pennsylvania, KePRO also has offices in Florida, Maryland, Ohio, Tennessee, and Virginia. KePRO is URAC health utilization management and case management accredited. For more information, visit http://www.kepro.org.
jbentele (at) kepro.org