3 Time-Saving Services Kepro Helps Medicare Clients With

---

Even for a Medicare agent like myself understanding all the rules of Medicare can be overwhelming. This is especially true for patients and family members who do not deal with Medicare on a daily basis. 

The good thing is there are Quality Improvement Organizations (QIO) that are there to help individuals navigate everything from complaints to appeals with clients. One of those organizations is called Kepro. 

In this article, I’ll share 3 Medicare-related services that Kepro offers to help you save time and worry. 

What Is Kepro?

Kepro is considered a Medicare Quality Improvement Organization. They are essentially an unbiased third party who helps Medicare patients, providers, and families with information and advocacy to help them better understand their rights under Medicare. 

Currently, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Texas and 28 other states. 

Essentially if you have a question or complaint about Medicare services you have received from a hospital, nursing home, or other medical provider Kepro is the organization that will help you. 

Who Can Use Kepro Services? 

Patients who have original Medicare or a Medicare Advantage Plan can call Kepro for assistance. 

3 Services That Kepro Helps Medicare Beneficiaries With  

Here are the most helpful services that Kepro can provide a Medicare patient or family member.

1. Advocacy for Medicare Patients

Some complaints may not be appropriate for a medical record review. Despite this, the complaint is still valid and Kepro can help you to better understand the situation and your rights as a Medicare client. 

How advocacy works is Kepro will contact the hospital, nursing home, or doctor on your behalf to get a better understanding and help you quickly resolve the problem. Kepro’s goal is to solve your issue between 8 hours and 2 business days. 

Examples of situations where advocacy would be appropriate would be: 

• Nursing home staff members refuse to answer your questions
• Your provided ordered durable medical equipment like an oxygen tank although it has not arrived
• You are running low on prescriptions but cannot get an appointment to see your doctor

If the medical provider does agree to work with Kepro or the medical treatment requested your next step would be to file a written complaint. This is something that Kepro can also help you with and we’ll talk more about this in the next section. 

Editor’s Note: To contact Kepro about advocacy Texas residents can call 216.447.9604 or 883.315.0635. If you live outside of Texas see their list of national helplines.

2. Helping Medicare Clients File Complaints

If you have tried working with the healthcare provider although you are not satisfied with the outcome, filing a complaint is another option that you have. 

To start this process, simply contact Kepro and they will help you to write out a formal complaint. 

After putting your complaint into words,  they’ll send your complaint to you for approval and signature. Once you send the formal complaint back they will then begin the quality of care review. 

Common complaints that Medicare clients contact Kepro for assistance include:

• Receiving the wrong medicine or a prescription with the wrong dose
• Providers give you a medical test that you did not need
• Your condition worsens and providers did not treat it
• A family member was neglected at a nursing home
• Wrong diagnosis
• You were discharged from the hospital and the instructions were not complete

Your complaint can be something totally different than the situations above and Kepro will still take your call.

3. Helping Medicare Clients File A Hospital Discharge Appeal 

The third service that Kepro offers is helping those with Medicare filing an appeal. 

If you feel you are being discharged from the hospital too soon, Kepro can help you to file an appeal.  

Editor’s Note: The hospital will give you a document called “An Important Message from Medicare”. This document explains that you can appeal a discharge decision. Typically this document is given around 2 days before your discharge. 

The way an appeal works is first you contact Kepro. Next, they will have a doctor review all your medical records to determine if you should be discharged. During the time it takes Kepro to come to a decision you will not: 

• Have to leave the hospital 
• Pay for extra days in the hospital while Kepro makes its decision

If you win your appeal you will get to stay longer. 

If you lose the appeal you will be asked to leave the hospital. If you still disagree with the decision you can file a reevaluation.  The only catch is if this reevaluation is denied you would be financially responsible for each day you stayed in the hospital past the date you filed the reevaluation. Essentially filing a reevaluation is a gamble because again you could be responsible for the cost of those extra days that you were in the hospital after your reevaluation. 

Skilled Services Appeals for Medicare Patients

You can also file an appeal if your skilled services stop, but you feel that you still need them. Typically when skilled services stop someone in the hospital will give you a form called Notice of Medicare Non-Coverage. On this form, it states that you can file an appeal. 

This process is similar to the hospital discharge appeal. A Kepro doctor will review your medical records and then make a decision on whether you should continue receiving skilled services or not. 

Beneficiary Care Management Program (BCMP)

This program helps Medicare client’s and families with services like: 

• Hospital discharge planning
• Help to navigate healthcare and your health insurance benefits

This is a good resource for overwhelmed family members who have questions about a Medicare client who is getting ready to discharge. To receive help from this program you must be referred by Kepro. 

Appeals for Medicare Advantage Plans

If you have a Medicare Advantage Plan and you cannot receive the care you need you can appeal. Common situations that Medicare Advantage clients appeal is: 

• Problems seeing a specialist
• Approvals for needed tests. This could be x-rays, MRIs, or blood tests. 
• Disagreements about your Medicare bill

Your Medicare Advantage Plan can provide information regarding an appeal, although if you need a decision quickly you can request an “expedited appeal”. 

You can call Medicare at 1.800.MEDICARE or visit the Medicare website for more information on filing a fast appeal. 

Conclusion

Trying to understand the rules of Medicare complaints, denials and appeals can lead to unnecessary headaches. While it’s a good idea to know your rights, you don’t have to be an expert because that’s what Medicare Quality Improvement Organizations like Kepro are for. 

If you have Medicare or a family member with the coverage and there are questions about a hospital discharge, you suspect neglect at a nursing home or any similar situations contact Kepro for help. 

If you are in Texas you can reach them at 888.315.0636 or visit the Kepro website.

Similar Articles That May Interest You: 

• How To File A Complaint On Your Doctor If You Disagree With Treatment
• This Hospital Discharge Guide Will Make You A Smarter Patient
• 17 Questions To Ask Before Your Hospital Discharge
• How Hospital Admissions Work