Posted on May 01, 2017
The Centers for Medicare and Medicaid Services (CMS) is changing the medical records selection process for patient status reviews for short stay inpatient hospital claims. Beginning in April 2017, Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) will no longer review short stay claims based on a hospital’s size. Rather, they will sample 25 cases for the top 175 hospitals with a high or increasing number of short stay claims per area, with 10 cases reviewed for other hospitals identified as having “major concerns” in the prior round of reviews.
In addition, KEPRO, Michigan’s assigned BFCC-QIO, will implement a new medical records process beginning in May 2017 for appeals. Barcodes correlating to the case identifier associated with the case will be included at the top of all fax request documents sent to providers and health plans by KEPRO. Providers and health plans are asked to include the request sheets with the barcode as the first sheet of each batch of records that are submitted to KEPRO. If there are multiple batches, the request sheet sent by KEPRO should be the first sheet of each batch.
Members with specific questions about these changes should contact KEPRO. Members with general questions should contact Jason Jorkasky at the MHA.
Tags: AHCA, ACA repeal and replace, Brian Peters, CMS, LTCH, Economic Impact Report, 2018 State Healthcare Budget, DSH, open enrollment, Excellence in Governance Fellowship, BCBSM, prenotification system, BFCC-QIO, KEPRO
Posted in: Monday Report
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