KEPRO Awarded CMS Beneficiary and Family-Centered Care (BFCC) Contracts

Ohio KEPRO  (KEPRO) was recently awarded three CMS Beneficiary and Family-Centered Care (BFCC) contracts that encompasses 34 states across the nation.  The Centers for Medicare and Medicaid Services (CMS) recently began restructuring the Quality Improvement Organization (QIO) Program to improve patient care, health outcomes, and save taxpayer resources.  This first phase of the restructuring awarded five areas of Beneficiary and Family-Centered Care (BFCC) QIO contractors to support the program’s case review and monitoring activities separate from the traditional quality improvement activities of the QIOs. 

QIOs historically have provided numerous quality improvement functions, including providing an infrastructure for national quality improvement initiatives across the continuum of care; today’s announcement highlights CMS’ efforts to restructure the QIO Program to gain efficiencies, to eliminate any perceived conflicts of interest, and to better address the needs of Medicare beneficiaries using BFCC QIOs to focus on providing patients a voice through conducting quality of care reviews, discharge and termination of service appeals, and other areas of required review in various provider settings.

KEPRO will be providing review of some or all of the professional activities of providers and practitioners in the QIO areas to Medicare beneficiaries; such reviews are for purposes of determining whether services are or were reasonable and medically necessary, whether the quality of the services meets professionally recognized standards of care, and, for inpatient services, whether the proposed services could be effectively provided more economically on an outpatient basis or in a different type of inpatient facility.  These reviews are integral to the determination whether items and services should be payable under the Medicare program.  “We are pleased and honored that CMS has selected KEPRO as the prime vendor to lead this initiative.  KEPRO has been serving as a Quality Improvement Organization for over 28 years and we are excited to continue and expand our partnership with CMS”, stated Joseph Dougher, KEPRO’s President and CEO.  

CMS and KEPRO will introduce the program changes with the beginning of its five year, 11th Statement of Work – the QIO contracts cycle – on Aug. 1, 2014. 

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Meghan Harris Guest Blogs on Managed Healthcare Executive

Meghan Harris, Chief Operating Officer for the Keystone Peer Review Organization, Inc. (KEPRO) wrote a guest blog for Managed Healthcare Executive. The post, titled Three Keys Lead to Better Health Care Management, promotes programs that help individuals better navigate the healthcare system and improve overall health.

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Benjamin Novinger, MS, Named KEPRO Director of Health Services Research

The Keystone Peer Review Organization, Inc. (KEPRO) today announced the hiring of Benjamin Novinger, MS, as Director of Health Services Research. Mr. Novinger will lead the scientific and technical evaluation of the efficacy of the Company’s care management and healthcare quality improvement programs.

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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.

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777 East Park Drive, Harrisburg, PA 17111
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Phone: 717.564.8288
Fax: 717.564.3862