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 MOA form and return the signed document to KEPRO by July 31, 2014:
We also request that you download the Provider Update form and return the completed form with your MOA so that we can update our records and better serve you.
Read more about MOA requirements. Read More
Medical Review and Care Management Company Is Poised for Accelerated Product Innovation and Growth
New York, NY, May 29, 2014 – Consonance Capital Partners, the private equity arm of Consonance Capital, a leading healthcare-focused investment firm, announced today that it has completed the acquisition of KEPRO from The Pennsylvania Medical Society. Founded in 1985, KEPRO is a leading medical management and cost containment solutions provider for government and private sector clients in the healthcare sector. Terms of the transaction were not disclosed.
Stephen McKenna, Managing Partner of Consonance Capital Partners, said, “KEPRO is an established national brand with an unparalleled reputation for quality in the medical management space, an area that will continue to experience strong demand as a result of shifting reimbursement models and changing regulatory requirements. We believe that KEPRO, with its world class employee base and talented management team, is poised for the next level of growth, and our investment and support for the business will help facilitate that success.”
Commenting on the transaction, Joe Dougher, President and CEO, KEPRO, said, “We are excited to work with Consonance and believe KEPRO will now be better positioned to capitalize on the many growth opportunities we are seeing in the market. We are confident that Consonance’s national reach as well as its financial and healthcare-specific industry expertise will solidify our commitment to our government and private sector customers, while improving outcomes for their members. This partnership will also enable us to accelerate our pace of expansion and contribute to the development of innovative products and services to complement our integrated suite of medical review and care management solutions.”
Consonance Capital Partners was advised by Latham & Watkins LLP, Foley & Lardner LLP, and Hogan Lovells US LLP. The Pennsylvania Medical Society was advised by McNees, Wallace & Nurick LLC. Fairmount Partners acted as the investment banker for the transaction.
About Consonance Capital
Consonance Capital is a healthcare investment firm that invests broadly across the healthcare landscape. Private investments, which include growth equity, leveraged buyouts, and recapitalizations, are made under the direction of Consonance Capital Partners, a private equity manager led by Mitchell Blutt, MD, Benjamin Edmands, Stephen McKenna, and Nancy-Ann DeParle. Public investments are made under the direction of Consonance Capital Management, a long/short public equity manager. Consonance Capital was established in 2005 and is located in New York City.
About The Pennsylvania Medical Society
The Pennsylvania Medical Society is comprised of 20,000 physicians and medical students working together to represent physicians in public venues, including the government, insurance companies, and the media, in order to advocate for patients and advance public health, public policy, medical science, education, and ethics. It also provides members with timely information, expert services, and professional support on medical practice issues. Read More
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. Read More