Review Services and Appeals
The Kansas Foundation for Medical Care, Inc. (KFMC) serves as the Quality Improvement and Peer Review Organization for the state of Kansas. KFMC has peer review contracts of medical cases with organizations such as the Centers for Medicare & Medicaid Services (CMS), Kansas Health Policy Authority (KHPA), and Kansas Department of Labor Worker's Compensation. KFMC serves as the external review organization for the Kansas Insurance Department (KID). Case review is made up of dedicated staff of healthcare professionals including nurses and coders. Physician consultants are available to carry out a complete and unbiased peer review of healthcare records, answering questions of appropriateness of care, quality of care, medical necessity, and coding.
Medicare & Medicaid Contracts
Case review work consists of review of medical records in various settings (e.g., hospital, skilled nursing facility, hospice, home health, etc) for quality, utilization, discharge and coding issues. Our responsibilities include a review of medical records to determine whether services meet professionally recognized standards of care, are medically necessary and are delivered in the most appropriate setting. When quality concerns are identified, we provide education and feedback to practitioners and other medical personnel to improve the quality of services received. Case review provides assistance in the areas of quality improvement activities.
KFMC also reviews discharges from certain healthcare settings to make sure a Medicare beneficiary is not being discharged too soon.
The case review team evaluates patterns of statewide practice variation and provides feedback and suggestions to the healthcare community for improving practice patterns. KFMC may refer issues to the Centers for Medicare & Medicaid Services (CMS) or to the Office of Inspector General (OIG) when identified concerns are egregious or not resolved.
Private Review Contracts
KFMC conducts peer review services for quality, utilization and coding issues under private review contract requests and requirements.