Beneficiary Services

A Quality Improvement Organization (QIO) is a group of health quality experts and clinicians organized to improve the care delivered to people with Medicare. QIOs work under the direction of the Centers for Medicare & Medicaid Services to assist Medicare providers with quality improvement and to review quality concerns for the protection of beneficiaries and the Medicare Trust Fund. When people with Medicare have a concern about their care, the Beneficiary and Family-Centered Care (BFCC) QIO can help them in different ways:

Immediate Advocacy

Using the Immediate Advocacy process to address complaints quickly

Quality of Care Complaints

Managing all complaints and quality of care reviews to ensure that the review process is consistent

Discharge and Services Appeals

Handling cases in which Medicare patients want to appeal a health care provider’s decision to discharge them from the hospital or stop other types of services

How Does Immediate Advocacy Help People with Medicare?

Immediate Advocacy is an informal process used by BFCC-QIOs to quickly resolve a Medicare care complaint within a few days. Examples of complaints that a BFCC-QIO may resolve through Immediate Advocacy include: lack of communication by healthcare staff, not receiving a piece of medical equipment, problems getting a prescription filled or refilled.

This 2-page resource is designed for people with Medicare and their families or caregivers to learn more about the BFCC-QIOs, what immediate advocacy is, and how it works.

How does Immediate Advocacy help people with Medicare? (PDF, 262 KB)

Find Your BFCC-QIO For Help with Appeals and Complaints

There are two QIOs (Kepro 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 regions, with each region being assigned to one of these two QIOs.

Area	BFCC-QIO	Phone	States
1	Kepro	888-319-8452	CT, MA, ME, NH, RI, VT
2	Livanta	866-815-5440	NJ, NY, PR, VI
3	Livanta	888-396-4646	DC, DE, MD, PA, VA, WV
4	Kepro	888-317-0751	AL, FL, GA, KY, MS, NC, SC, TN
5	Livanta	888-524-9900	IL, IN, MI, MN, OH, WI
6	Kepro	888-315-0636	AR, LA, NM, OK, TX
7	Livanta	888-755-5580	IA, KS, MO, NE
8	Kepro	888-317-0891	CO, MT, ND, SD, UT, WY
9	Livanta	877-588-1123	AS, AZ, CA, GU, HI, MP, NV
10	Kepro	888-305-6759	AK, ID, OR, WA

Beneficiary and Family Engagement

The BFCC NCORC regularly works with beneficiaries and their families to gather input about how to improve the care and services delivered under the BFCC-QIO program. Interested in lending your voice to quality improvement initiatives? Contact the BFCC NCORC to learn more.

Addressing Your Concerns

Although BFCC-QIOs strive to provide the highest quality of service and support for Medicare Beneficiaries and their Representatives, they may sometimes fall short of your expectations. Should you wish to express concern and speak with someone regarding the quality of service or support you received from your BFCC-QIO, contact qioconcerns@cms.hhs.gov. We value your opinion and recognize the need to take account of every individual beneficiary experience. Your communication is important and helps us improve the BFCC-QIO Program and we appreciate you doing so.

BFCC-QIO

How does

Effective February 1, 2022, the Beneficiary Care Management Program (BCMP) is no longer accepting new referrals for care management services. Beneficiaries are encouraged to continue working with their respective regional Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO) for assistance. For more information please visit https://qioprogram.org/locate-your-qio on how to locate the BFCC QIO that services your area. Thank you.