Case Review Connections

Medical Director's Corner

Written by Jessica Whitley, MD, MBA

Tips for Healthcare Providers When Responding to BFCC-QIO Correspondence

As a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), Acentra Health completes quality of care reviews for beneficiary complaints, referrals, and appeals as needed. When a potential quality of care concern is identified, providers and practitioners will have a chance to respond before the concern is confirmed. This is all done through written correspondence.

These reviews are conducted in the spirit of collaboration and quality improvement to assist providers in refining their processes, not as a punitive measure. Furthermore, Acentra Health typically does not report this information to other oversight agencies, and all reviews are protected under federal confidentiality regulations.

To assist providers and practitioners in responding to correspondence related to these reviews, here are some helpful tips:

1. Ensure Accurate Address Information: Acentra Health faxes correspondence to the number listed in the Medicare database. Please verify that your contact information is up to date.
2. Adhere to the Centers for Medicare & Medicaid Services (CMS) Time Frames: The time frames for responses are mandated by CMS. As a CMS contractor, Acentra Health must enforce these deadlines.
3. Provide Specific and Relevant Information: Respond to the questions thoroughly and include all necessary clinical details. Acentra Health’s Peer Reviewer will evaluate the response to determine whether the concern is resolved or confirmed.
4. Await Notification: Acentra Health will notify you or your facility of the review determination.
5. Prioritize Timely Responses: Please take the correspondence seriously and ensure your response is submitted within the specified time frame.

By following these guidelines, you can help facilitate a smooth and effective quality review process. For more information, visit the Beneficiary Complaints page.

Appeals update - Hospital Observation Appeals

Observation appeals have started, and we are getting questions about the new review. If you have questions, please visit our provider appeals page which has helpful links. If your question isn’t answered by that page, send an email to QIOCommunications@acentra.com. (Please do not send protected health information [PHI] via email.)

Resources to Help You Share Medicare Rights Information

Acentra Health has posters available in both English and Spanish with information about Medicare rights that you can share with your patients/clients. Materials are available to download for free.

YouTube Shorts

Acentra Health has a new YouTube Short about Medicare Rights that is available in both English and Spanish. Please share these links in your newsletters or other informational pieces.

Health Observance - Older Americans Month

In May 2025, Older Americans Month will celebrate the theme "Flip the Script on Aging," challenging outdated stereotypes and promoting a more vibrant, inclusive view of aging. The campaign encourages active engagement and recognizes the valuable contributions of older adults. Learn more about how you can participate at the Administration for Community Living website.

Rural Health

Do you work in rural health? For a hub of resources, visit the Rural Health Information Hub. It has an online library, topic guides, tools for success, and much more! It would also be helpful to bookmark this site for future reference.

Feedback

We value your feedback. Please let us know if there is any content that you would like to see covered in our stakeholder/provider newsletter by emailing QIOCommunications@acentra.com.