KEPRO MEMORANDUM OF AGREEMENT – Additional Information for Clarification

QIO Program

In 1982, Congress established Utilization and Quality Control Peer Review Organizations (PROs) (now known as QIN – QIOs) to perform two broad functions:

promote quality health care services for Medicare beneficiaries, and
determine whether services rendered are medically necessary, appropriate and meet professionally recognized standards of care.

CMS also contracts with QIOs to validate provider-coding assignments, which affect reimbursement. The goal of the QIN – QIO program is to improve the processes and outcomes of care for Medicare beneficiaries. The QIN – QIO is to achieve this goal through performance of various directives promulgated by CMS in the QIN – QIO Contract, as discussed below.

GMCF is the QIN – QIO in Georgia doing the (a) section of this work as outlined above.

KEPRO is now the QIN – QIO in Georgia doing the (b) section outlined above.

Purpose of Agreement with KEPRO
The purpose of this Agreement is to define the administrative relationship that will exist between parties in the exchange of data and information. This Memorandum of Agreement is required by the Medicare statute and regulations as well as the QIO Manual and certain QIO contract directives. It is also intended to be informational. The QIO wants to inform Georgia hospitals, home health agencies, skilled nursing facilities, Medicare Advantage organizations, critical access hospital, […]

July 22nd, 2014|Quality Corner|

Quality Improvement Organization 11th Statement of Work, KEPRO MEMORANDUM OF AGREEMENT

In order to participate in the Medicare program, federal law requires certain providers to have a Memorandum of Agreement (MOA) with a Quality Improvement Organization (QIO). MOAs are informational and outline the QIO's and provider's responsibilities during the review process.

Medicare providers in the Centers for Medicare & Medicaid Services (CMS) Areas 2, 3 and 4 (District of Columbia, Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, North Dakota, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wyoming, Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio and Wisconsin) need to return a signed MOA to KEPRO by July 31, 2014.

Please download the attached KEPRO informational letter, the KEPRO MOA, the Provider Update Form and visit the website for more information –

July 21st, 2014|Quality Corner|

GHCA Members Honored With Seven Out of 77 Silver National Quality Awards

AHCA/NCAL recently announced the recipients of the 2014 Silver Achievement in Quality Award – and an impressive seven of the 77 recipients are GHCA members.

GHCA members being honored are:
Cartersville Heights
Legacy Nursing and Rehabilitation Center of Atlanta
PruittHealth – Forsyth
PruittHealth – Toomsboro
PruittHealth – Valdosta
Southland Health and Rehabilitation of Peachtree City
The William Breman Jewish Home of Atlanta.
Silver is the second level in the AHCA/NCAL National Quality Award journey and recognizes a significant step in the journey toward performance excellence. In 2014, 77 centers across the country achieved the Silver award. This represents 26% of applicants, an increase over the 20% recognition rate in 2013.

This recognition for GHCA members means the association has met its Strategic Plan goal of earning seven Silver National Quality Awards in 2014.

“This prestigious award honors select centers across the nation that serve as models of excellence in providing high-quality long term care,” said Jon S. Howell, president and CEO of the Georgia Health Care Association. “I am proud that we had such a strong showing in this national awards process. It clearly demonstrates the ongoing commitment of GHCA members to providing consumers with access to high quality care here in Georgia.”

Implemented by AHCA/NCAL in 1996, the National Quality Award Program is centered on the core values and criteria of the Baldrige Performance Excellence […]

July 16th, 2014|News, Quality Corner|

HCBS Transition Plan to comply with CMS Community Setting Rules

HCBS Transition Plan
Georgia begins process to address new regulations issued by CMS for Home and Community Based Services

The Centers for Medicare & Medicaid Services (CMS) have issued regulations that define the settings in which it is permissible for states to pay for Medicaid Home and Community-Based Services (HCBS), otherwise known as waiver services. The purpose of these regulations is to ensure that individuals receive Medicaid HCBS in settings that are integrated and that support full access to the greater community. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as individuals who do not receive HCBS.

Georgia is beginning to look at how our waivers may need to be modified to comply with the new regulations. The process for how we plan to review waiver policies and service settings must be outlined in a written Transition Plan and submitted to CMS with a waiver amendment. Before submitting to CMS, stakeholder comment must be gathered to assure the public has had an opportunity to inform the Transition Plan.

Georgia will first be submitting an amendment for the Elderly & Disabled Waiver to ensure compliance with the new HCBS rules. We have developed a draft Transition Plan […]

July 10th, 2014|Reimbursement Corner|

Regional Healthcare Coalitions

GHCA member organizations build new and stronger relationships with other healthcare organizations, learn about available resources in the community, have their concerns heard and addressed in the planning process, and have access to training and grant funding. All health care organizations are needed and invited to become members and support their region’s Healthcare Coalition. Members regularly attend meetings, participate in the planning process, and agree to work with and support other members during disaster response and recovery. Please contact the Council Coordinator in your region (listed below) for more information. To determine what Region in which your facility falls, please view this RCH Region Map.





Suzanne Stanley
Jennifer Haislip
Golden Living Center – Rome
Bill Arthur
Wooddale Health & Rehab

Marsha Beck, R.N.
Brown Memorial Convalescent Ctr.
Tamey Stith
Gwinnett Extended Care Facility
Henry Roberts
New Horizons North

Metro Atlanta
Dr. John Lawal
Westbury Health & Rehab
Kimnie Bennett
Arrowhead Healthcare Center
Wendy Meinert, RN
Bombay Lane, LP
Angela Daugherty
A. G. Rhodes Home-Cobb

West Central
Mary Jane Cleveland
Twin Fountains Home
Trylene Brown
Magnolia Manor Nursing
Columbus East

Middle Georgia
Donna Holman
The Retreat
Michael Barry
Boilingreen Health and Rehab

East Central
Elaine Black, RN
Emanuel […]

July 7th, 2014|Emergency Preparedness, Regional Coalition Updates|

Georgia Health Care Association Director of Assisted Living Membership

Director of Assisted Living Membership
Seeking experienced individual for the development, recruitment, and retention of assisted living and personal care facilities for Georgia Health Care Association. Knowledge of assisted living, excellent communication skills, and the ability to use social media preferred. College degree with an emphasis in marketing preferred. Apply online below, or email your cover letter and resume to by July 14, 2014.
Located in Stockbridge, GA.
Full-time position.
Directly responsible for the development, recruitment, and retention of assisted living and personal care facilities meeting the criteria of such allied membership.  This individual shall be able to provide advocacy, licensing and regulatory assistance, educational programming and professional development to GHCA’s assisted living allied membership and provide quality member services to attract and retain membership while fulfilling the responsibility of monitoring and being conversant with public policy issues affecting such member services.
College Degree with an emphasis on marketing and sales study and/or experience with a commitment to developing and building the membership of GHCA in its newly created and defined assisted living allied membership category.
The candidate should maintain oral and written communication and marketing skills with proven experience and training in marketing and sales that will be used to demonstrate the benefits, features, and value of membership as an allied member of GHCA. […]

July 7th, 2014|Classified Ads, GHCA|

Visit to GHCA Member Helps State Officials Gain Greater Understanding

GHCA recently arranged for staff members of the Georgia Department of Community Health (DCH) Division of Financial Management to visit A.G. Rhodes Health & Rehab of Atlanta as part of the Association’s efforts to show policymakers quality care in action.
Getting DCH staff more knowledgeable about skilled nursing care centers is one of the GHCA’s strategic plan goals.  This partially completes one of the action plans – visiting nursing centers in both urban and rural settings.
"Support from state partners such as the Department of Community Health is critical in helping residents in skilled nursing facilities get the high-quality care that they need and deserve," said Jon Howell, president and CEO of the GHCA. "Tours like these highlight the important role that facilities like A.G. Rhodes play in serving Georgia’s older population."
In addition to a tour of the facility, guests observed therapy sessions, including horticultural and music therapy. 
Participating in the tour were DCH staff Tim Connell, CFO; John Upchurch, Director of Reimbursement; Darryl Threat, Program Manager; Angelica Clark, Reimbursement Manager; and, Margaret Betzel, Counsel.

June 30th, 2014|News, Newsfront|

Annual Quality Report Now Available

The newest edition of the GHCA Quality Report is now available for download at
Created as a way to share information about the commitment of Georgia providers to quality, the Quality Report provides an analysis of the long term care of today as well as data on reimbursement and its impact on providers. The report also contains an overview of quality programs and a review of satisfaction measures.
Each edition of the Quality Report analyzes data from the preceding year. Our new edition analyzes 2013 data.
Members looking for information for presentations or who need a handy source of benchmark data will find the report useful.
Click here to download your copy of the 2013 Quality Report please.

June 30th, 2014|News, Newsfront, Quality Corner|

MedPAC Report Includes Recommendation for Site-Neutral Payments 

MedPAC (the Medicare Payment Advisory Commission) has announced the release of its June 2014 Report to the Congress. The Commission’s June 2014 report examines a variety of Medicare payment system issues. In the seven chapters of this report they consider: synchronizing Medicare policy across payment models, improving risk adjustment in the Medicare program, measuring quality of care in Medicare, financial assistance for low-income Medicare beneficiaries, per beneficiary payment for primary care, site-neutral payments in post-acute care settings, and measuring the effects of medication adherence for the Medicare population.
Below is a short summary of the sections from the MedPAC report that are of greatest interest to our membership:
Synchronizing Medicare policy
Historically, Medicare has had two main payment models: traditional fee-for-service (FFS) and Medicare Advantage (MA). Traditional FFS pays for individual services according to the payment rates established by the program. By contrast, under MA, Medicare pays private plans capitated payment rates to provide the Part A and Part B benefit package. Starting in 2012, Medicare introduced a new payment model, the accountable care organization (ACO), which pays for care on an FFS basis but includes incentives for providers to reduce unnecessary care while improving quality. The Commission believes that, […]

June 30th, 2014|News, Newsfront|

July 1, 2014 Starts Submission of HIPPS Codes 

The Centers for Medicare & Medicaid Services (CMS) released guidance by way of the Nov. 4, 2013 Health Plan Management System (HPMS). The notice informed Medicare Advantage Organizations (MAOs) and other entities that, effective for dates of service (DOS) on or after July 1, 2014, a ‘Reject’ disposition status will be generated for the omission or improper submission of Health Insurance Prospective Payment System (HIPPS) codes for skilled nursing facilities (SNF) and home health (HH) encounters. On May 23, 2014, CMS released an HPMS notice, entitled "Submission of Health Insurance Prospective Payment System (HIPPS) Codes to Encounter Data System." This notice provided MAOs and other entities with additional details regarding the requirement for submission of HIPPS Codes for SNF and HH encounters. CMS encourages MAOs and other entities to continue to work with SNF and HH providers to meet this requirement. The following institutional error codes will generate a ‘Reject’ disposition on MAO-002 reports for the omission or improper submission of SNF and HH encounters:

22390 – HIPPS Code required for SNF/HH
22395 – HIPPS Code conflicts with Revenue Code
22400 – HP Qualifier must exist for HIPPS Code

Health Insurance Prospective Payment System (HIPPS) rate codes […]

June 30th, 2014|News, Newsfront|