BFCC-QIO Services
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BFCC-QIO Services
Acentra Health is a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Through the BFCC-QIO program, we help protect the rights of people with Medicare (also referred to as Medicare beneficiaries) by reviewing certain appeals and quality of care concerns and by helping resolve some healthcare concerns through Immediate Advocacy.
BFCC-QIO services are funded by the Centers for Medicare & Medicaid Services (CMS) and are available at no cost to Medicare beneficiaries.
What Are BFCC-QIO Services?
BFCC-QIOs help people with Medicare when they have certain concerns about their health care.
Acentra Health provides three key types of BFCC-QIO services:
Appeals
Independent reviews when a Medicare beneficiary disagrees with certain decisions about ending Medicare-covered care or services.
Quality of Care Complaints
Reviews of complaints about whether health care provided to a Medicare beneficiary met professionally recognized standards of care.
Learn More About Quality of Care
Immediate Advocacy
Help resolve certain healthcare concerns by improving communication between a Medicare beneficiary and their healthcare provider or facility.
Appeals
Appeals help protect the rights of Medicare beneficiaries when they believe a decision to end certain Medicare-covered care or services is wrong.
Acentra Health conducts independent reviews of eligible appeals. Depending on the situation, an appeal may involve a hospital stay, skilled nursing facility care, home health services, hospice services, or certain changes in hospital status.
Hospital Discharge Appeals
A Medicare beneficiary may request an appeal when they are told that their covered hospital stay is ending but believe they are not ready to leave.
Hospital inpatients receive a notice called the Important Message from Medicare (IM) that explains their discharge appeal rights and how to request a review.
Skilled Service Appeals
A Medicare beneficiary may also have appeal rights when certain Medicare-covered services are ending, and they believe those services should continue.
These may include:
- Skilled nursing facility services
- Home health services
- Hospice services
A Notice of Medicare Non-Coverage (NOMNC) explains when these covered services are ending and how to request an appeal.
Hospital Observation Appeals
Certain people with Original Medicare have the right to appeal when a hospital changes their status from inpatient to outpatient receiving observation services.
This change can affect how much the patient pays and whether Medicare will cover care in a skilled nursing facility after they leave the hospital.
Eligible patients receive a Medicare Change of Status Notice (MCSN) explaining the change and their right to request an appeal.
Quality of Care Complaints
People with Medicare can file a complaint when they have concerns about the quality of health care they received.
Examples may include:
- Receiving the wrong medication or too much of a medication
- Receiving a surgery or medical test they didn’t need
- Receiving an incorrect diagnosis
- Receiving incomplete discharge instructions
- A change in condition that wasn’t treated
Quality of care complaints include a medical record review to determine whether the care provided met professionally recognized standards of care.
Immediate Advocacy
Immediate Advocacy is a free service for people with Medicare that can help resolve certain concerns about medical care or services quickly.
The process often involves Acentra Health helping facilitate communication between the Medicare beneficiary and their healthcare provider or facility.
Immediate Advocacy may be appropriate for concerns such as:
- Hospital staff not answering a patient’s questions
- A delay in receiving equipment ordered by a healthcare provider
- Questions or concerns about the discharge planning process
If Acentra Health determines that Immediate Advocacy is appropriate, we will ask for permission to share the individual’s name and concern with the provider. If the provider agrees to participate, Acentra Health works with both parties to help resolve the concern as quickly as possible, often through a phone call.
If the provider cannot participate, Acentra Health will discuss other options that may help address the concern.
Immediate Advocacy Discharge Assistance
Immediate Advocacy Discharge Assistance, or IADA, is available to people with Original Medicare who contact Acentra Health with concerns about a planned discharge from an acute care hospital.
IADA may be appropriate when a hospitalized patient has been told that discharge is planned but has questions or concerns about the discharge process.
The service can help:
- Clarify the discharge plan
- Support communication between the patient and hospital staff
- Make sure the patient’s concerns are acknowledged
Immediate Advocacy Discharge Assistance is not an appeal. It doesn’t affect appeal rights or deadlines and does not include clinical review, medical record review, determinations of medical necessity, or changes to discharge timing.
Related Links
Help People Know Their Medicare Rights
Your organization can help people with Medicare understand their rights and know where to turn when they have concerns about their health care.
Visit our Advocacy Resources page for ready-to-use materials you can share in your community.
Have Questions About BFCC-QIO Services?
Our team can help answer questions about Acentra Health’s BFCC-QIO services and partner educational opportunities.
Please send an email to: QIOCommunications@acentra.com