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Do You Know Your Beneficiary QIO?

QIOs, or Quality Improvement Organizations, represent one of the largest federal programs on health care quality, and AAAs are increasingly partnering with QIOs to expand access to programs for Medicare beneficiaries and duals with chronic conditions. 

QIOs are great resource to help AAAs implement, expand and improve the quality of diabetes self-management training (DSMT), medical nutrition therapy (MNT), chronic care management and more.

But recently, CMS separated QIOs into two distinct types: facility-focused QIOs and beneficiary and family care QIOs (BFCQIOs). The latter is an important resource for your clients with Medicare quality issues, so get to know which of the two contracted BFCQIOs serves your geographic area. 

The Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) Program ensures that Medicare beneficiary needs are better met by designating a special type of organization, a Beneficiary and Family Centered Care (BFCC)-QIO to help Medicare beneficiaries exercise their right to high-quality healthcare. BFCC-QIOs manage all beneficiary concerns and appeals, quality of care reviews, cases of suspected “patient dumping” covered by the Emergency Medical Treatment and Labor Act (EMTALA), and other types of case review. They are available to assist Medicare beneficiaries who wish to appeal their discharge from a hospital or their termination from skilled services, including home health, skilled nursing, hospice, and comprehensive outpatient rehabilitation. When Medicare beneficiaries have a complaint that is not related to the clinical quality of healthcare, they and their healthcare provider can agree to participate in a flexible, dialogue-based resolution process, called Immediate Advocacy. Examples of complaints that may be resolved through Immediate Advocacy:

·        Complaints about a lack of communication by hospital staff
·        Concerns about the failure to receive a motorized scooter, wheelchair, or another piece of equipment
·        Difficulty scheduling an appointment for a prescription refill
 
Accessing your local BFCC-QIO
The two designated BFCC-QIOs, Livanta and KEPRO, serve all 50 states and three territories, which are grouped into five areas.

Helplines by Area
 
Northeast and Caribbean: (Livanta) 1-866-815-5440
Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Vermont, and the U.S. Virgin Islands.
Mid-Atlantic and Southeast: (KEPRO) 1-844-455-8708
Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia.
Mountain, North Central, and South: (KEPRO) 1-844-430-9504
Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, New Mexico, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, and Wyoming
Midwest: (KEPRO) 1-855-408-8557
Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, and Wisconsin.
West: (Livanta) 1-877-588-1123
Alaska, Arizona, California, Hawaii*, Idaho, Nevada, Oregon, Washington, and the Pacific Territories. *Hawaii includes the Pacific Territories of American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands.
Visit http://qioprogram.org/about/what-are-qios to learn more about these and other services offered by the QIO Program.

 

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