Livanta, a Medicare Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), has been awarded a national contract by CMS to perform Medicare claim review audits. These audits will include short stay reviews, higher weighted diagnosis related group reviews (HWDRGs), and other reviews as directed by CMS. This claim review by the BFCC-QIO is different and separate from the existing BFCC-QIO case review services for beneficiary appeals and quality of care complaints provided by Kepro. The Washington State Hospital Association (WSHAs not involved in the audits but has been asked to help Livanta facilitate communication to member hospitals. At this point, the exact timing of the reviews has not been determined but we will provide more information as it becomes available. WSHA will also be monitoring the process and request member hospitals to let us know if they are experiencing issues with Livanta’s processes.
In preparation for the audits, hospitals are required to sign a memorandum of agreement (MOA) with Livanta to facilitate communications with the appropriate parties for the exchange of medical records and to review findings. More information and a link to Livanta’s website with the online MOA form and contact update form are here. (Andrew Busz, AndrewB@wsha.org)