KEPRO Info for Stakeholders and Provider Resources

The information below can be used to communicate the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Program changes to Medicare beneficiaries in your area. Please insert the appropriate information where noted, and copy and paste the content into newsletters, on your organization’s website, or as appropriate in other forms of communication.

The Centers for Medicare & Medicaid Services (CMS) has restructured the Quality Improvement Organization (QIO) Program to further enhance the quality of services to Medicare beneficiaries. Effective August 1, 2014, KEPRO is the new Beneficiary and Family Centered Care QIO (BFCC-QIO) for the state of Kentucky. Previously, the QIO in Kentucky was Healthcare Excel. KEPRO will strive to keep a local presence by having outreach staff throughout the area and using state-specific physician reviewers, whenever possible, to provide review determinations at the local level. The same beneficiary protection services will continue to be provided to Medicare beneficiaries. This includes the right for a Medicare beneficiary and his/her representative to contact KEPRO:

  • To file a quality of care complaint about the quality of health care received from a Medicare provider.
  • To file a discharge appeal when a beneficiary is being discharged from a hospital or skilled services (including a skilled nursing facility, home health services, or hospice).
  • For assistance with an immediate problem by requesting Immediate Advocacy.

For more information about KEPRO’s services, please visit their website at www.keproqio.com.