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Overview of Services for Healthcare Providers We are the Beneficiary and Family Centered Care Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome! |
related links
- Appeals
- Beneficiary Complaints
- Other Reviews
- Medical Record Electronic Submission
- Educational Resources
- Physician Acknowledgement Monitoring
- QIO Liaison
- Memorandum of Agreement
- Update Your Contact Information
- Become a Peer Reviewer
- Case Status Check
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You can learn more about Acentra Health by subscribing to Case Review Connections.
Consider signing up if you are a healthcare provider providing services in one of the states served by Acentra Health and receive Medicare payments.
overview
Acentra Health is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for 29 states. As part of the BFCC-QIO contract with the Centers for Medicare & Medicaid Services (CMS), Acentra Health provides free services to people who have Medicare including:- Hospital discharge and skilled service termination appeals
- Quality of care reviews
- Immediate Advocacy
BFCC-QIOs are part of the QIO Program, which is one of the largest federal programs dedicated to improving health quality for people who have Medicare. The mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to people who have Medicare.
Read more about the QIO Program.
how acentra health works with healthcare providers
Acentra Health reviews Medicare hospital discharge and skilled service termination appeals and quality of care reviews. Cases are referred to us for a quality of care review from a variety of sources including people with Medicare (e.g., Medicare patients) and their families or representatives, CMS, and Medicare Administrative Contractors (MACs).
The QIO Liaison at your facility will distribute written information from Acentra Health to the appropriate department or administrative leader. Be sure your facility’s contact information is up to date, so you don’t miss any important communication from Acentra Health.
Acentra Health is also responsible for monitoring physician acknowledgement statements for hospitals. Because hospitals are paid under the prospective payment system based on the physician's diagnoses, all newly credentialed physicians must sign a statement that remains on file at the facility before their first admission to the hospital or first claim submission.
action items for healthcare providers
- Update your facility's contact information. Be sure your information is up to date, so you don’t miss any important communication from Acentra Health. Your facility can change the designated QIO Liaison at any time by notifying Acentra Health in writing.
- Update physician acknowledgement statements and send to Acentra Health annually.
- Check appeals status online. Use the Case Status tool to check the status of an appeal that has been started.
technical denial policy
Pursuant to 42 C.F.R. § 476.90, as amended on August 31, 2012, at 77 Federal Register pages 53258, 53664-665, 53682-683, the BFCC-QIOs’ authority to issue technical denials applies to providers or practitioners of any kind, regardless of setting, when they do not submit the medical records requested.
The regulations also indicate that those providers and practitioners that refuse to allow a BFCC-QIO “to enter and perform the duties and functions required under its contract with CMS” may also be subject to a technical denial. Therefore, a BFCC-QIO may impose a technical denial where providers and practitioners do not comply with the requirements for case review as opposed to simply failing to submit medical records.
