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.

in this issue:

• Medical Director's Corner
• Appeals Update
• Acentra Health Resources - PSAs and Medicare Rights Video
• Rural Health Updates
• National Caregivers Awareness Month

medical director's corner - jessica whitley, md, mba

Medical Record Submission

Post-acute appeals represent one of the highest-volume appeal types reviewed by Acentra Health. Detailed data on appeal volumes can be found in our Annual Reports.

Because of the high number of post-acute appeals, it is critical that the Centers for Medicare & Medicaid Services (CMS) deadlines are strictly followed. While Acentra Health strives to be accommodating to providers, timeliness and completeness of submissions are essential for fair and efficient processing.

Key Points:

• Timely Submission Required:
  If medical records are not submitted by the required deadline, the appeal will automatically be decided in favor of the beneficiary.
• Complete Documentation:
  All necessary information must be included on the Medical Records Request Form. If required details are missing, the physician reviewer will also issue a decision in favor of the beneficiary.
• Impact of Late or Incomplete Submissions:
  A decision in favor of the beneficiary requires issuance of a new notice, potentially restarting the entire appeal process.

Resources:

• Educational Support:
  Acentra Health offers educational videos on both documentation standards and the medical record submission process via our YouTube channel.
• Need Assistance?
  If you encounter difficulties submitting medical records, please contact the Acentra Health Helpline for assistance.

Appeals Due Dates:

Post-acute: By close of business (COB) local time on the day of notification.

appeals update

Regarding records submission: Please take extra care to upload records for one Medicare patient at a time. Each patient record should be accompanied by a unique case ID. We’ve seen an increase in submissions where multiple patients are included under a single case ID, which can cause delays.

Case ID numbers: The format of the appeals Case ID numbers will be changing soon to a 9-digit number. This change will affect both the Case Status tool and the medical record upload file.

Video: Please share our updated Medicare appeals video with patients and others you serve if they have questions about appeals or the appeals process.

acentra health resources - psas and medicare rights videos

We’ve developed two new resources to help you learn about our services.

• Public service announcements (PSAs): Available in English and Spanish, these 30-second spots highlight our Appeals and Immediate Advocacy services.
• YouTube video: A short 2-minute overview designed specifically for Medicare beneficiaries. Visit the Medicare Rights Video page on our website to access a toolkit for guidance on how to use the video most effectively.

We invite you to explore these new resources and share them with others who may benefit.

rural health updates

CMS announced new guidance for states seeking funding from the $50 billion Rural Health Transformation Program, established under the Working Families Tax Cuts Act. This historic investment is the largest in rural health care to date. It aims to modernize infrastructure, expand access, and improve quality and outcomes across rural America.

United States Health and Human Services Secretary, Robert F. Kennedy, Jr., and CMS Administrator, Dr. Mehmet Oz, emphasized that the program will deliver long-term, sustainable improvements that ensure dignity, affordability, and dependable care for rural communities.

Program Goals:

• Healthier communities: Expand preventive care and address root causes of disease.
• Sustainable access: Help rural providers operate efficiently and remain viable care hubs.
• Workforce development: Recruit and retain skilled health professionals in rural areas.
• Innovative care models: Improve outcomes through coordinated and flexible care approaches.
• Technology innovation: Advance digital health, data security, and efficient care delivery.

Learn more and access the Notice of Funding Opportunity: CMS Rural Health Transformation Program.

Watch CMS' message on the program’s impact: YouTube Video.

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

Publication No. R146810-215-11/2025. 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.