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Beneficiary and Family Centered Care (BFCC)-QIOs
Kepro Service Areas
Kepro Service Areas
Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIO) help Medicare beneficiaries with their concerns about the quality of care they receive from a Medicare provider. The Quality Improvement Organization (QIO) is a group of health quality experts, providers, and consumers organized to improve the quality of care delivered to people with Medicare.
The BFCC-QIOs (Kepro) review complaints and quality of care and help to improve the effectiveness, efficiency, economy and quality of services provided to people with Medicare. BFCC-QIOs provide services to help with complaints and quality of care reviews.
You can also contact your BFCC-QIO for help in filing an appeal in a hospital or non-hospital setting if you think your coverage is ending too soon (for example, if your hospital says that you must be discharged and you disagree). You have the right to a fast appeal if you think your Medicare-covered services are ending too soon.
Contact your BFCC-QIO to ask questions or report concerns about the quality of care you received for a Medicare-covered service (and/or if you are not satisfied with the way your provider has responded to your concern). For more information or help, contact your BFCC-QIO. Also, if you have any issues or further concerns after filing a quality of care complaint or a discharge appeal with your designated QIO, please contact the CMS QIO Concerns Mailbox for assistance.
Podcast offered by the Association of State and Territorial Health Officials (ASTHO)
APRIL 19, 2024 | 29:57 MINUTES
The social determinants of health (SDOH)—the social, economic, and built environments in which people live, learn, work, and play—have significant impacts on health outcomes. Yet, sustainably funding initiatives that address SDOH is an ongoing challenge. In this episode, Admiral Rachel Levine, MD, assistant secretary for health at HHS, and Danielle Nelson, Senior Program Analyst at the Federal Transit Administration, discuss the federal government’s commitment to aligning investments and resources across agencies. In addition, Elizabeth Hertel, director of the Michigan Department of Health and Human Services, provides a practical example of how Michigan’s state health agency works collaboratively with the housing authority to ensure access to stable housing.
Guests
Admiral Rachel Levine, MD: Assistant Secretary for Health, HHS (Alum-PA)
Elizabeth Hertel: Director, Michigan Department of Health and Human Services
Danielle Nelson: Senior Program Analyst, Federal Transit Administration
Resources
Tips for Coding OASIS N0415 High-Risk Drug Classes
Tips for Coding OASIS N0415 High-Risk Drug Classes
Current Reconciled Drug Regimen – Code a medication that is part of a patient’s current reconciled drug regimen, even if it was not taken at the time of assessment.
This could include new medications the patient has not started.
This could include medications that have a frequency of every few weeks or monthly.
No CMS Resources for Drug Class – CMS does not specify a resource for determining drug classification and/or therapeutic category.
No Need for Drug Class to Match Reason for Use – The drug classification does not have to match the reason why the patient is taking that medicine. If the medicine falls into one of the drug classifications and has a patient-specific indication noted, then both columns 1 and 2 should be checked for that drug.
Drugs in More than One Class – If a single drug could be classified into two different drug classes, then both drug classes should be checked for that drug.
Don’t Include Herbal and Alternative Meds – Herbal and alternative medicine products should not be considered when answering this question, even if they are a part of the current reconciled medication drug regimen.
Discharge Consideration – Do not code N0415 based on what is expected to occur at discharge.
Don’t Code Flushes for IV Ports – Flushes used to keep an IV port patent should not be coded in N0415.
Coding None of the Above
If at least one of the drug classes A through J is selected, then Z through None of the above should not be selected.
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