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Beneficiary Complaints 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! |
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medical record electronic submission
Effective October 1, 2020, the Centers for Medicare & Medicaid Services (CMS) requires providers to send medical records to Acentra Health electronically.
Read more about the medical record electronic submission process.
quality of care reviews
Medical record review is the traditional option to resolve a quality of care complaint under Medicare. This is at no cost to the beneficiary (e.g., Medicare patient).
When Acentra Health, a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), receives a written complaint about the quality of services received by a Medicare beneficiary, Acentra Health will request a copy of the medical record. A doctor of matching specialty will review the medical record. The review process could take four to six weeks to complete, during which the BFCC-QIO will keep the person who made the complaint informed of the progress of the review. When the review is complete, the BFCC-QIO notifies that person of the final result of the complaint.
When a review confirms a quality concern, it is referred to the Quality Innovation Network Quality Improvement Organization (QIN-QIO) for quality improvement activities and to engage healthcare providers in making system changes to prevent a similar problem from occurring in the future.
This Process Flow Chart (PDF) shows the appeals process on page 1 and the beneficiary complaint process on page 2.
