Administrative Memos

200506

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 02, 2005
SUBJECT: QUALITY IMPROVEMENT ORGANIZATION REVIEW OF MEDICARE FEE-FOR-SERVICE BENEFICIARY APPEALS OF TERMINATION OF COVERAGE FOR HOME HEALTH CARE, NURSING FACILITY AND COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY SERVICES
IPRO CONTACTS:

Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, extension 423

As you may already be aware, effective July 1, 2005, IPRO, the Quality Improvement Organization (QIO) for New York, will begin to review Medicare Fee-for-Service (FFS) beneficiary requests for expedited appeals, should they receive a provider-issued denial for Medicare coverage of services. This new appeal process is being established in accordance with the Benefits Improvement and Protection Act (BIPA) ?521. (For further information, please refer to the November 26, 2004 Federal Register, Volume 69, No. 227; "Final Rule Medicare Program: Expedited Determination Procedure for Provider Service Terminations.").

The purpose of this memorandum is twofold:

1. To provide you with information about upcoming training sessions that will be conducted by IPRO in regard to the Quality Improvement Organization (QIO) review process under the Benefits Improvement and Protection Act (BIPA); and
2. To request contact information from your organization that will facilitate this new appeals process.

1. Training Information

IPRO will be holding provider-training "webinar" sessions (i.e., via conference call and the Internet) in regard to this new process during the last two weeks of June. The sessions are scheduled as follows:

Due to the number of available phone lines (maximum 200 lines per call), attendance is by registration only. However, recorded sessions will be made available online at IPRO's website, www.ipro.org subsequent to the training dates.

Detailed registration instructions are included in Attachment I. Participants will need access to both the Internet and a telephone line. (If you do not have Internet access, please contact Lori DeRise at 516-326-7767, extension 364 for further instructions.) We request your assistance in keeping slots open for all who wish to participate; please encourage participating staff to share the computer/phone line used for the training event.

2. Contact Information

The appeal process requires that the beneficiary or beneficiary's representative contact IPRO by noon of the day following receipt of the notice to request an appeal. IPRO will receive these appeals seven days a week (including weekends and holidays) during business hours (8:30 a.m. to 4:30 p.m.). IPRO must then contact you, the facility/provider of services (at the time of the appeal) in order to request medical records and any other required information

To facilitate this appeal process, IPRO is requesting contact information for your organization. Please complete the attached "Contact Form" (Attachment II) and return it to the attention of Lori DeRise (either by fax or e-mail) in the Department of Medicare/Federal Health Care Assessment no later than June 21, 2005.

Should you have any questions or require additional information, please do not hesitate to contact Alice Vallar, Senior Director, Medicare/Federal Health Care Assessment, 516-326-7767, extension 423 or Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment, extension 364.