Recent changes to the Quality Improvement Organization (QIO) Program were made to ensure that Medicare beneficiary needs are better met by designating a special type of organization, a Beneficiary and Family Centered Care (BFCC)-QIO, to address all beneficiary concerns and appeals, quality of care reviews, cases of suspected “patient dumping” covered by the Emergency Medical Treatment and Labor Act (EMTALA), and other types of case review.
BFCC-QIOs help Medicare beneficiaries exercise their right to high-quality healthcare. They manage all beneficiary complaints and quality of care reviews to ensure consistency in the review process while taking into consideration local factors important to beneficiaries and their families. They also handle cases in which beneficiaries want to appeal a health care provider’s decision to discharge them from the hospital or discontinue other types of services. Beneficiary experiences, both good and bad, give the QIO Program the perspective to identify opportunities for improvement, develop solutions that address the real needs of patients, and inspire action by health professionals.
While BFCC-QIOs are the primary point of contact for Medicare beneficiaries and their families, quality of care complaints can also be made by calling 1-800-MEDICARE.
The two designated BFCC-QIOs, Livanta and KEPRO, serve all 50 states and three territories, which are grouped into five regions depicted in the Locate Your BFCC-QIO map.
BFCC-QIO Annual Reports
Each year, the BFCC-QIOs provide reports to the Centers for Medicare & Medicaid Services (CMS) reflecting services provided to Medicare beneficiaries. Within this report, you will find regional and state-level data that reflects work completed from August 1, 2016 through July 31, 2017. The reports include information such as:
- Number of medical record reviews completed
- Top 10 principal medical diagnoses
- Quality of care concerns confirmed and quality improvement initiatives
- Discharge/service terminations
- Evidence used in decision making
- Immediate Advocacy success stories
The annual reports for each U.S. region are below.
Northeast and Caribbean:
Connecticut, Massachusetts, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Virgin Islands, Vermont
Mid-Atlantic and Southeast:
Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia
Mountain, North Central, and South:
Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, New Mexico, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wyoming
Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington