BFCC-QIOs Help Medicare Recipients Exercise Rights to High-Quality Health Care

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Doctor and elderly woman talking at a table
Doctor and elderly woman talking at a table

In 2014, the Centers for Medicare & Medicaid Services (CMS) restructured the Quality Improvement Organization (QIO) Program to better address the needs of Medicare beneficiaries. As part of the new structure, CMS designated two Beneficiary and Family Centered Care (BFCC)-QIOs to oversee all beneficiary appeals, quality-of-care complaints and case reviews.

BFCC-QIOs provide beneficiaries an avenue for voicing their concerns about health care quality or disputing decisions related to their care. Patients can submit complaints about the care they received or appeal a health care provider’s decision to discharge them from the hospital, skilled services or other care settings. They can also contest coverage or payment decisions made by Medicare.

The Program’s two regional BFCC-QIOs, Livanta and KEPRO, work to ensure consistency in the review process while considering local factors relevant to individual cases. While providing a forum for beneficiary feedback, these organizations also offer support by advising beneficiaries on available options, equipping them with the information necessary to make informed decisions, assisting with complaint or appeal submissions, and providing translation services when necessary.

Helping Medicare recipients exercise their right to quality health care represents the QIO Program’s continued push toward a more patient-centered philosophy of care – a principal aim of the current CMS Quality Strategy. In turn, Quality Innovation Network (QIN)-QIOs use the beneficiary feedback to identify opportunities for improvement, develop solutions that address the real needs of patients and inspire health professionals to take action toward change.

KEPRO and Livanta recently launched online tools to allow providers and beneficiaries to more quickly and efficiently check the status of cases. As of June 2015, Livanta and KEPRO reported a combined 103,547 online status requests since the launches of their online tools in January and February 2015 respectively. The majority of requests have been from providers. By enabling providers to check case statuses on BFCC-QIO websites, KEPRO and Livanta have been better able to focus on responding to calls from beneficiaries.

The BFCC-QIO role is one of many QIO Program elements designed to foster a more engaged patient population.

To find your BFCC-QIO, use this interactive map.

To access Livanta and KEPRO’s case status online tools, please visit the following websites:

KEPRO

Livanta Area 1

Livanta Area 5