What is a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO)?
“A Quality Improvement Organization (QIO) is a group of health quality experts, clinicians, and consumers organized to improve the quality of care delivered to people with Medicare…BFCC-QIOs help Medicare beneficiaries exercise their right to high-quality health care. They manage all beneficiary complaints and quality of care reviews to ensure consistency in the review process while taking into consideration local factors important to beneficiaries and their families. They also handle cases in which beneficiaries want to appeal a health care provider’s decision to discharge them from the hospital or discontinue other types of services. Two designated BFCC-QIOs serve all 50 states and three territories, which are grouped into ten regions.”¹
Who are the BFCC-QIOs?
Kepro and Livanta are the two contractors that serve as the BFCC-QIOs for all fifty states and three territories, which are grouped into ten regions.
Kepro
Region 1: Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont
Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee
Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, Texas
Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
Region 10: Alaska, Idaho, Oregon, Washington
Livanta
Region 2: New Jersey, New York, Puerto Rico, U.S. Virgin Islands
Region 3: Delaware, Maryland, Pennsylvania, Virginia, West Virginia, Washington D.C.
Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin
Region 7: Iowa, Kansas, Missouri, Nebraska
Region 9: Arizona, California, Hawaii, Nevada, Pacific Territories
BFCC-QIO 2023 Annual Reports
In late February, Kepro and Livanta released their Annual Medical Services Review Reports for 2023 which includes data for claims with dates of service from January 1, 2023 through October 31, 2023.
Livanta noted in their March 5th edition of The Livanta Compass, that they prepare “a report for each of the five regions it serves, highlighting data points and the accomplishments of each specific region. Although each report is tailored to a particular region, the processes and individuals who safeguard the rights of Medicare beneficiaries remain consistent across all the regions that Livanta serves.”
Each report includes data at the region and state level.
The data in Table 6 (Beneficiary Appeals of Provider Discharge/Service Termination and Denials of Hospital Admission Outcomes by Notification Type) in the annual reports includes the number of appeal reviews and percentage of reviews for each outcome in which the peer reviewer either agreed or disagreed with the hospital discharge or discontinuation of skilled services. The following Appeals Notification Types are included in table 6:
- Notice of Non-coverage Fee-for-Service (FFS) Preadmission/Admission – Admission and Preadmission/HINN 1,
- Notice of Non-coverage Request for BFCC-QIO Concurrence - HINN 10,
- Medicare Advantage Appeal Review for Comprehensive Outpatient Rehabilitation Facilities (CORFs), Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), Value-Based Insurance Design (VBID) Model Hospice Benefit Component – Grijalva,
- FFS Expedited Appeal (CORF, HHA, Hospice, SNF) – BIPA,
- Notice of Non-coverage Hospital Discharge Notice – Attending Physician Concurs (FFS hospital discharge), and
- MA Notice of Non-coverage Hospital Discharge Notice – Attending Physician Concurs (MA hospital discharge).