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- Provider Outreach and Education Advisory Group (POE-AG)
Palmetto GBA Welcomes Livanta
During our December 2019 POE-AG meeting, Palmetto GBA partnered with the new beneficiary QIO for providers and families in Virginia and West Virginia. QIO representatives Bryan Fischer and Leasa Novak, introduced themselves to POE-AG members and gave an overview of the services they provide for Medicare beneficiaries and providers.
Below are the talking points from that introduction for review and distribution to providers.
- Providers outside of Virginia and West Virginia will continue to be serviced by KEPRO
- If you're not familiar with the BFCC-QIO program, we are the Medicare Quality Improvement Organization that handles what we call "case review" for Medicare beneficiaries and families
- The largest scope of work that we handle is for Medicare appeals. If you are in an inpatient status in a hospital, or if you are admitted in a skilled nursing facility, a hospice, a home health agency or a comprehensive rehab facility, you — as a Medicare beneficiary or a representative of a Medicare beneficiaries — probably all now have the right to appeal your discharge or your termination of services. Livanta is the organization that reviews those appeals for Medicare.
- Livanta also handles beneficiary complaints. It is just like the name implies. Medicare beneficiaries and their families (and their representatives) have the right to file a complaint about any care that they received within the last three years. Livanta is the organization that handles that complaint review for Medicare beneficiaries. We also have a relatively new service called “immediate advocacy.” This is essentially a real-time dispute resolution service. If a patient or representative calls Livanta either within appeal or a complaint, we will ask them if they would like to voluntary participate in immediate advocacy.
- If a patient agrees to immediate advocacy, we will sign them a patient advocate who will then try to resolve whatever the issue that the patient or family member has with the provider without having to go through the full appeal or the full quality review. This is an increasingly popular service. It has a very high rate of patient and provider satisfaction because we are able to resolve issues without having to go through a full case review.
- If you haven't already done so, make sure all your Medicare patient notices have been updated to include the new QIO to read “Livanta.” If you're in Virginia or West Virginia, make sure that you remove KEPRO from any of your Medicare information.
- There are a couple of responsibilities that we ask providers to help us out with. We manage them on behalf of Medicare. The most important one at this time is a universal message for all providers: regardless of whether you are in Livanta service territory in Virginia and West Virginia, or if you're outside of that in North Carolina or South Carolina, a Memorandum of Agreement (MOA) is required between your facility and your QIO (The MOA does NOT apply to Part B providers. The POE-AG has members that provide services for all lines of business [LOBs], so it is important to cover for Part A and Home Health.)
- The MOA is a Memorandum of Agreement. The Memorandum of Agreement is a pretty mild legal document that outlines the legal relationship between the provider as a Medicare-certified provider and the Quality Improvement Organization in your state. If you are in Virginia or West Virginia, you need to have an MOA signed with Livanta.
- If you're in North Carolina or South Carolina, you need to have an MOA signed with KEPRO. You may have signed an MOA prior to May or June of this year. Those MOAs are now invalid because they do reference the previous contract cycle which ended on June 8, 2019, regardless of whether or not you have a previous MOA signed and a new MOA is now due.
- Both Livanta and KEPRO are being held to the same standard by CMS for measurement. One hundred percent of all of our providers are going to be required to have an MOA on file and we're going to be held to that. The transition period officially ended about a month ago. Livanta sent out a few notifications regarding the need for a new MOA. Palmetto GBA has also assisted us with messaging efforts.
- At the end of December, we will begin an internal audit to determine if your facility has completed an MOA. We will notify providers in the New Year about the results of that audit. We will then begin to work with those providers to ensure that they have completed their MOA. At some point in 2020, probably in the second quarter, we will be notifying CMS (as is required under the terms of our contract) the providers that have either refused or failed to comply with the MOA requirement. So, it is a requirement, it is statutory. It is actually listed in Section 42 of the Social Security Act that providers are required to have an MOA with the QIO in their state.
- If you haven't already done so, please make sure that you take this opportunity to go back to your administrative folks and make sure that the MOA is completed and it is on file with Livanta. The form itself is fairly easy to complete. It's a fillable PDF, so all you have to do is download the PDF from our website which is livantaqio.com. Select the provider tab and then the select the MOA option. Or, there is a banner across the main page right now directing you straight to the MOA page. Next, download the PDF. Fill out the PDF and you can simply e-mail it or fax it into us. Please be aware that if you do send the MOA back by fax it will add a couple of days to the processing time. So the fastest, most efficient way is to email it to us and it will actually be process automatically. You should receive an auto-reply message indicating that we received your MOA. If you don't get that, check your spam filter or your junk mail box. Sometimes these messages have been getting caught up there. In that way you can have verification for your records that we didn't receive your MOA.
- As a best practice, we recommended an annual MOA review. Each year, you should take a look at your MOA and make sure that the points of contact that you listed in your MOA, such as phone numbers, fax numbers, emails, personnel, etc., are still valid. That is a major difference between Livanta's MOA and KEPROs. The Livanta MOA contains all of the point of contact for your hospital or your facility. KEPRO generally in the past has maintained the separate contact sheet (four points of contact) rather than doing it through the MOA. We try to simplify things — to have a single document, that's a little bit less work for you. We do ask you to name all of your points of contact in the MOA. There are a several different ones. Probably the most critical is your appeals contact, medical records contact. We have kind of a correspondence contact that's going to receive all of the outcome letters by mail. And then finally there is a remittance contact. This is another important thing for us.
- If you're not familiar, the QIO program has the ability to reimburse you for pages and post it under certain circumstances. However, what we found in the last contract, over the past five years, that billing offices were not really sure what to do with the checks when they came in, because we may have done three or four different chart reviews. And as a result of that, that reimbursement check might be, for instance, $30.25, but it's not going to be affiliated with a single patient, so providers didn’t know which account they should apply the credit to. That check needs to be cashed and deposited into your general fund or wherever you deem necessary. Business is different in every facility, but you do need to cash that check. And they're going to be for generally a minimum amount of money, but we do ask for remittance contact on your MOA so that that person knows that they are going to be receiving kind of random checks occasionally from Livanta.
- This is the biggest requirement that we are working through right now. So again, if you haven't done your MOA, please make sure that you do that as soon as possible.
- We want to make sure that all of you as providers know that we are here at your disposal. If you have questions, if you have concerns, if you are not sure what's going on, please do feel free to call us at any time. We are available Monday through Friday, 9 a.m. to 5 p.m., and then weekends and holidays from 11 a.m. to 3 p.m.
- If you have general questions that do not contain PHI or PII, you are more than welcome to email the communications department. If you have questions about our policy or procedures, please feel free to email us directly.
- You can contact by email at firstname.lastname@example.org. No PHI or PII to this inbox that is monitored weekdays during business hours. This is a general inbox and it's monitored by the communications team during business hours on the weekdays.
- For case and clinical related questions please call 888–396–4646 (Monday through Friday 9 a.m. to 5 p.m. and weekends and holidays 11 a.m. to 3 p.m.)
- We are also available to provide supplemental education on a facility-by-facility basis. If you would like for us to provide a 30-minute refresher webinar, or if there is a specific topic you would like us to cover through webinar, please email us that request to email@example.com and we are more than happy to work with you at an individual provider level or through our partners here at Palmetto GBA.
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