Free Service for People with Medicare

It has been more than a year since COVID-19 reached the United States, and seniors continue to have questions and concerns about this virus that has been particularly troubling for people over 65. As Medicare beneficiaries, they can get help by using free resources provided by the federal government through Kepro, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for 29 states. Kepro provides three services for Medicare beneficiaries: Immediate Advocacy, decisions on appeals of hospital discharge and skilled service termination, and reviews of quality of care complaints.

Immediate Advocacy helps foster a quick solution to a healthcare concern. Typically, Kepro intervenes with the provider, usually by phone, to try to find a solution to the problem. Here is an example of Immediate Advocacy:

A Medicare patient’s husband called Kepro with concerns about his wife’s discharge from a skilled nursing facility. During a care conference with the surgeon, it was determined that the patient’s husband was capable of taking care of his wife with help from home health services. However, once his wife was home, he had questions. He called Kepro to request help with understanding the plan of care and treatment options. Kepro scheduled a three-way conference call with the skilled nursing facility’s social worker and the patient’s husband. The plan of care was discussed further during the call, and the patient’s husband gained a better understanding of his wife’s treatment options.

The discharge appeals process provides a Medicare beneficiary who does not feel medically ready to be released from the hospital the opportunity to appeal the discharge via Kepro. This service is also available for skilled services, such as physical therapy. The beneficiary’s appeal goes to a Kepro physician reviewer, who reviews the patient’s medical records to determine if the additional treatment is needed.

Kepro also examines quality of care complaints from Medicare beneficiaries involving the medical care they have received. If a Medicare beneficiary believes they received the wrong care, Kepro’s physician reviewers can examine the medical records to determine if the care was appropriate. Here is an example of a quality of care complaint that can be reviewed:

A Medicare beneficiary went to the emergency department with a stroke. There was a delay in treatment, and the window for the proper medication was missed. The beneficiary’s symptoms worsened. The beneficiary believed if the treatment had started sooner, the outcome would have been better.

For more information about Kepro, visit www.keproqio.com. A graphic at the bottom of the web page connects to educational YouTube videos that provide further information about the services offered by Kepro. The website also offers resources, such as information cards that can be printed and kept on a refrigerator or placed in a wallet, that can be found by clicking on the link for Advocacy Resources.

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