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Case Review Connections
A Newsletter for Healthcare Providers and Stakeholders Acute Care Edition Issue 44: May 2025 Do you receive the Case Review Connections newsletter? If not, sign up for Acentra Health's email list to receive important news and updates as well as the bi-monthly newsletter. |
If you want to communicate BFCC-QIO information, please email Acentra Health at QIOCommunications@acentra.com and request a newsletter insert or fact sheet for your organization. Please do not copy and paste information from Case Review Connections.
webinar: may 21, 2025 - 2 pm et
Want to learn more about the basics of the BFCC-QIO?
This webinar will provide a very general overview of the services that the BFCC-QIO offers for Medicare beneficiaries (beneficiary complaints, appeals, and Immediate Advocacy services).
This webinar will be beneficial for new staff or someone new in their role as well as stakeholders that work with people with Medicare.
For more information and to register, visit our registration page.
new podcast episode
Learn about the Senior Medicare Patrol (SMP) from Crystal Strong, Program Director, South Carolina Department of Aging. The SMP assists with fighting Medicare fraud and has suggestions about how to do that.
in this issue:
medical director's corner - 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:
- Ensure Accurate Information: Acentra Health faxes correspondence to the number listed in the Medicare database. Please verify that your contact information is up to date.
- Adhere to the Centers for Medicare & Medicaid Services (CMS) Time Frames and Prioritize Timely Responses: The time frames for responses are mandated by CMS. As a CMS contractor, Acentra Health must enforce these deadlines.
- 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.
- Await Notification: Acentra Health will notify you or your facility of the review determination.
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.
If you find the information in this newsletter useful, please encourage your co-workers and colleagues to sign up: https://acentraqio.com/newsletters
Publication No. R146810-134-04/2025. This material was prepared by Acentra Health, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
