News

APS Healthcare is Now KEPRO; Florida’s Preadmission Screening and Resident Review Program Enhanced with Change

HARRISBURG, PA – APS Healthcare announced today that it will be serving the citizens of Florida as KEPRO, leveraging expertise and continuing its partnership with the Florida Department of Children and Families to build healthier communities through the Preadmission Screening and Resident Review (PASRR) program to ensure individuals receive appropriate care.

Since 2007, APS Healthcare has been supporting the state in ensuring that no individual with a serious mental illness is inappropriately placed in a nursing home by completing PASRR Level II evaluations and determinations. When nursing home level of care is found to be needed, the program will work to ensure that the patient’s mental health needs are also met.

As part of the rebranding initiative KEPRO unveiled the new website, http://flpasrr.kepro.com/ that includes enhanced usability and content to further assist Florida’s members and providers, alike.

“This change really emphasizes our dedication to providing additional value to meet our client’s and their member’s specific needs,” stated KEPRO President and CEO Joseph A. Dougher. “KEPRO continuously delivers on our promise of providing Intelligent Value and this new website and its functionality does just that.”

The new website provides quick and easy access to essential information and programs to assist individuals, families and providers in getting the resources they need. The site is enhanced with richer online content that is easy to navigate. The new website will be updated on a regular basis to ensure that content is always up-to-date and accurate.

In May of 2015, APS Healthcare was acquired by KEPRO, a leading quality improvement and care management organization. The combination has enhanced KEPRO’s ability to provide comprehensive and high quality service offerings through an integrated approach and customized solutions.

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 and McKesson to Share Guidance for Understanding the Two-Midnight Rule and Avoiding Denials at 2016 ACMA National Conference

Rare opportunity to gain insight into BFCC-QIO’s perspective on short-stay inpatient admissions, to help improve decisions and reduce denials

Harrisburg, PA - Executives from McKesson Health Solutions and KEPRO will share the podium at the ACMA 2016 National Conference to help providers better understand how to reduce denials, the Centers for Medicare & Medicaid Services’ (CMS) final Two-Midnight Rule and the Beneficiary and Family Centered Care audit process. Co-presenting at the conference, being held April 2-6 in Tampa, Fla., will be Tammie Phillips R.N., McKesson’s Vice President, Business Consulting, and Cheryl Cook R.N., KEPRO’s Program Director for CMS Areas 2 and 4.

“Many providers are still confused by the Two-Midnight Rule and how it relates to medical necessity and overall care management program considerations”

Their interactive session, “Denials Management, the Two-Midnight Rule, and the QIOs Perspective,” will be held on April 5th at 10:30 a.m. ET. Phillips and Cook will discuss provider trends and challenges around denials management, with particular focus on the impact of the updated rule. They will share insights on the BFCC-QIO audit process and expose common gaps in provider workflows. This is a unique opportunity to hear perspectives directly from one of only two BFCC-QIOs charged by CMS to audit short-stay claims and ask questions.

“Many providers are still confused by the Two-Midnight Rule and how it relates to medical necessity and overall care management program considerations,” Phillips says. “Knowing what to expect requires an understanding of correct documentation of medical necessity, how the QIOs will conduct the audit process and the tools they will use to support their short-stay inpatient reviews. Our session will shed light on these challenges and opportunities, which are crucial advantages for reducing denials.”

The 23rd annual American Case Management Association (ACMA) National Conference will convene over 1,500 case management and transitions of care professionals for ongoing training, education, and networking, to strengthen their skills within the practice setting. A long-time supporter of ACMA, McKesson will be exhibiting and answering attendees’ questions at ACMA booth #312.

For more information on the ACMA 2016 National Conference, visit http://casemanagementconference.com. For more information about McKesson Health Solutions, please visit www.mckesson.com and follow us on Twitter at @McKesson_MHS. For more information about KEPRO, please visit our website, ‘Like’ us on Facebook or follow us on Twitter at @KEPRO_PA

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KEPRO Awarded New Contract in Minnesota for Emergency Medical Assistance

HARRISBURG, PA – KEPRO announced today it was recently awarded a new contract with the state of Minnesota to manage the Emergency Medical Assistance Program on behalf of the Minnesota Department of Human Services.

“We’re excited to expand our services for the state of Minnesota,” said Joe Dougher, President and Chief Executive Officer. “Over the past 3 years we have worked to provide utilization management for the state’s Medicaid program and this opportunity allows us to further enhance our healthcare services 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’s clinical team, based in Bloomington, determines the medical necessity of various healthcare procedures, treatments, and health services, including mental health services for both children and adults, dental services, and durable medical equipment.

With the new contract, KEPRO will provide services to support the management of the Emergency Medical Assistance (EMA) program. EMA 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. EMA also covers some care and treatment provided in other settings without which a patient’s health would be in serious jeopardy, including dialysis and cancer treatments. KEPRO will review submitted Care Plan Certification requests to determine if individuals meet established criteria for coverage.

KEPRO, a leading quality improvement and care management organization, offers innovative and outcomes-focused solutions to reduce the utilization of health care resources and optimize quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. To learn more about KEPRO, visit www.KEPRO.com.

 

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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