What is the QIO Program?
The Quality Improvement Organization (QIO) Program is led by the Centers for Medicare & Medicaid Services (CMS) and is aimed at improving the quality and reducing the cost of health care that Medicare beneficiaries receive. The QIO Program comprises experts in health quality, clinicians, consumers, and other stakeholders who work to improve the standard of healthcare delivery. The QIO Program is one of the largest federal programs dedicated to improving health quality for those with Medicare. Since 1984, the Program has evolved to become a keystone for ensuring people with Medicare get they care they deserve, which ultimately improves care for everyone.
What are Beneficiary and Family Centered Care (BFCC)-QIOs?
BFCC-QIOs manage appeals and disputes from Medicare beneficiaries by reviewing the quality of care delivered by hospitals and other healthcare institutions. BFCC QIOs address individual complaints, such as appeals for decisions to be discharged from hospitals and the discontinuation of other health care services, as well as any potential violations of the Emergency Medical Treatment and Labor Act (EMTALA). BFCC QIOs also protect the Medicare Trust Fund by determining whether services rendered and paid for by CMS are reasonable and necessary.
BFCC-QIO Area Map
There are two QIOs (Acentra Health and Livanta) that work directly with beneficiaries to address their appeals and complaints. QIOs serve all U.S. states, territories, and the District of Columbia. The country is divided into ten regions, with each region being assigned to one of these two QIOs.
For more information about the program, visit the
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