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KEPRO to Implement Minnesota’s Retrospective Review Program for State Medicaid

HARRISBURG, PA – KEPRO announced today that it was awarded a new contract with the state of Minnesota Department of Human Services to perform all retrospective, post-payment reviews for the state’s fee-for-service Medicaid program.

KEPRO will be developing and implementing the state’s first program to conduct retrospective and post-payment reviews to identify outpatient and inpatient initiatives to enhance the delivery of services and improve overall health outcomes for members of the state’s Medicaid program.

“We’re grateful for this opportunity to continue our work in the state of Minnesota,” said KEPRO President and CEO Joseph A. Dougher. “This program allows us to identify areas where we can deliver outcome-focused solutions to maximize services and improve the quality of life for Minnesotans.”

KEPRO currently manages Minnesota’s Fee-for-Service Medicaid program and helps 315,000 members receive the quality care they need through utilization management. KEPRO also supports the management of the Emergency Medical Assistance (EMA) program that covers the care and treatment of non-citizens who would otherwise qualify for Medicaid for emergency medical conditions provided in the Emergency Department or inpatient hospital. In addition, KEPRO performs reviews for level of service requests for non-emergency transportation for Fee-for-Service recipients to and from appropriate health care providers and facilities.  

KEPRO’s reviews will identify outliers that indicate policy gaps, training needs, and trends in order to encourage best practices in medical care, record keeping, and billing. KEPRO will also be reviewing provider claims to ensure that documentation adheres to the Minnesota Health Care Programs Provider manual, nationally recognized clinical criteria and best practices for medical claims coding.

“We’ll be assisting Minnesota in ensuring efficiency and program integrity in the delivery of Medicaid services for their citizens,” stated Dougher.

To learn more about the services and solutions KEPRO offers, visit www.kepro.com.

You can also get health tips, information about our organization or learn about exciting job opportunities by following us on Twitter, on  Facebook or on LinkedIn.

Media Contact: Jamie Kopko, Director of Corporate Communications, JKopko@Kepro.com, 717.564.8288 x7076

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KEPRO Announces Appointment of Business Development Vice President

HARRISBURG, PA – KEPRO is pleased to announce the appointment of Anne C. Chappuie as Vice President of Growth and Development.

Ms. Chappuie, a 20-year health care market strategist, will be supporting KEPRO in state and federal government business development. Ms. Chappuie will support KEPRO’s growth plan, identifying new opportunities to establish business relationships, supporting internal teams on proposal development, product solution development and revenue optimization.

“Anne’s expertise as a health care executive and key strategist will play a critical role in demonstrating KEPRO’s value to our current and future clients,” said KEPRO President and CEO Joseph A. Dougher.

Ms. Chappuie has decades of experience in program integrity, business operations, development/capture management, revenue optimization and quality improvement. Most recently, Ms. Chappuie’s firm provided strategic consulting services focused on solution approach and positioning.

Previously, Ms. Chappuie was the Vice President of Business Development and Sales Management for Advent Health Partners, Vice President of Government Strategy and Business Development for Optum, Inc., Vice President of Development and Account Management for Bloodhound Technologies, Inc. and Vice President of Financial Services for Maximus, Inc.

Ms. Chappuie received her Bachelor of Science degree in Public Administration and her Masters of Health Administration from the University of Southern California.

To learn more about the services and solutions KEPRO offers, visit www.kepro.com.

You can also get health tips, information about our organization or learn about exciting job opportunities by following us on Twitter, on  Facebook or on LinkedIn.

Media Contact: Jamie Kopko, Director of Corporate Communications, JKopko@Kepro.com, 717.564.8288 x7076

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KEPRO’s Hilary Moles Recognized as Nursing Leader in West Virginia

HARRISBURG, PA – KEPRO announced today that Case Manager and Clinical Assessor Hilary Moles, BSN, RN, of KEPRO’s West Virginia’s Administrative Service Organization was recognized by the Future of Nursing West Virginia Action Coalition with the 40 Under 40 Nursing Leadership Award.

The Future of Nursing coalition is led by three co-sponsoring organizations, the West Virginia Nurses Association, the West Virginia Hospital Association, and the West Virginia Organization of Nurse Executives, and is the driving force for transforming the culture of health and health care through nursing in the state. This organization works to address the increased demands for health care by using all the skills, talents, knowledge, and experience of nurses to guide implementation of the recommendations from the Institute of Medicine.

“We’re incredibly proud of Hilary’s accomplishments and her much deserved recognition,” said KEPRO President and CEO Joseph A. Dougher. “Hilary is part of an exemplary team in West Virginia and her hard work and dedication is an example of what all of us strive for on a daily basis at KEPRO.”

The Future of Nursing West Virginia’s 40 Under 40 Award recognizes local nurse leaders in the community for their leadership contribution in community affairs and professional organizations. The award also recognizes individuals who positively promote and advance nursing in the community through volunteerism, outreach efforts or legislative and policy development.

Hilary Moles’ passion and commitment to excellence were just two of the reasons she was awarded the 40 Under 40 award. Hilary is dedicated to health care reform through education, mentoring, volunteering and partnerships with physicians and other health care providers in West Virginia. Hilary will be the Future of Nursing WV Action Coalition health ambassador working to educate children in her community on the importance of health and wellness.

“I am honored to be recognized by the Future of Nursing West Virginia,” stated Hilary Moles. “I believe that collaboration and education are the cornerstones to achieving health literacy and wellness within our communities. I am committed to leveraging my experience and expertise to advocate for these as a foundation of our community’s overall health.”

To learn more about the services and solutions KEPRO offers, visit www.kepro.com.

Media Contact: Jamie Kopko, Director of Corporate Communications, JKopko@Kepro.com, 717.564.8288 x7076

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Please describe KEPRO data security that ensures member information is protected.

As an organization that is charged with storing and transferring Protected Health Information (PHI), KEPRO is bound by HIPAA regulations, and is accustomed to managing the security and privacy of PHI. KEPRO currently exchanges data successfully and confidentially via secure encrypted means in support of all of our federal, state, and local government programs, and with commercial clients.

KEPRO has been implementing and supporting systems that require medical record, data security, and transmission for more than a quarter of a century, and has always placed primary importance on using systems that allow for fast and efficient connectivity, while still providing the highest level of data and system security. Our proven internal and external policies and protocols ensure compliance with state and federal laws and regulations, as well as any additional security measures you may require.

We have a stringent KEPRO Comprehensive Confidentiality Plan that governs our processes. KEPRO’s Privacy Officer, Security Officer, and the Compliance Officer have ultimate responsibility for oversight of the processes and procedures contained in the KEPRO Comprehensive Confidentiality Plan.

KEPRO's system is secure. Our information systems are secured by an in-depth strategy that utilizes multiple layers of operational, management, and technical controls to protect KEPRO assets. We also employ software programs designed to prevent unauthorized use by staff or outside entities.

All KEPRO information systems employ common security controls such as Firewalls, Anti-virus, Role Based Access, FIPS 140-2 Encryption for mobile devices, and the requirement of strong passwords. Information system users are assigned a security role based upon access requirements relevant to their positions and information/program privileges.

The HIPAA Security Rule requires entities to implement information systems that control access to healthcare and related systems. KEPRO adopts a subset of NIST 800-53 Rev 3 Security controls to maintain compliance with HIPAA. Based on these security standards, KEPRO mitigates risk to its Information system by focusing on such controls as:

  • Log-In Security. HIPAA security requires the use of secure User IDs and the use of passwords. KEPRO requires multiple account authentication processes within its information systems to verify the identities of our end-users. KEPRO's policy requires strong passwords that are changed frequently.
  • Access Control. HIPAA requires one of the following: Context Based Access, Role Based Access, or User Based Access. User Based Access is part of the Log-In Security component. KEPRO's Role Based Access gives individual users access relevant to their function in the organization.
  • Audit Trail. HIPAA requires the use of an audit trail to identify who accesses PHI. KEPRO systems track those who change the patient record, the date and time the record was modified, and the specific information changed. The system includes a read only audit trail that captures each time a system user views a case.
  • Session Time-out. KEPRO information systems account for session inactivity by locking screens after 10 minutes of inactivity.
  • KEPRO's physical space is secure. KEPRO’s computer, telephone, and hardware systems are located in climate controlled rooms with fire-suppression and electronic locking system. We allow only authorized access to the room.
  • KEPRO focuses training on confidentiality and security issues. All KEPRO employees undergo rigorous training on security and confidentiality of PHI. We have successfully provided this training to all staff regardless of their respective roles/duties.

KEPRO Headquarters

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777 East Park Drive, Harrisburg, PA 17111
Toll-free: 800.222.0771
Phone: 717.564.8288
Fax: 717.564.3862