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:
Using the Immediate Advocacy process to address complaints quickly
Managing all complaints and quality of care reviews to ensure that the review process is consistent
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.
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.
CT, MA, ME, NH, RI, VT
NJ, NY, PR, VI
DC, DE, MD, PA, VA, WV
AL, FL, GA, KY, MS, NC, SC, TN
IL, IN, MI, MN, OH, WI
AR, LA, NM, OK, TX
IA, KS, MO, NE
CO, MT, ND, SD, UT, WY
AS, AZ, CA, GU, HI, MP, NV
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 firstname.lastname@example.org. 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.
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.