What is the role of the BFCC-QIO?
BFCC-QIOs are responsible for medical case review, which supports the rights of people on Medicare. These rights include protecting you when you get health care and making sure you get the health care services the law says you can get. BFCC-QIOs can help you if you have a concern about the care you have been receiving or if you want to request a review (appeal) of your discharge from a health care facility.
BFCC-QIOs also review all medical records received to make sure that the care you received was reasonable, necessary, and provided in the most appropriate setting.
In addition, every month, the BFCC-QIO reviews the medical records for hospital stays where the hospital made an update to the coding of the patient's diagnoses and any procedures performed after an original submission of the coding to Medicare. This coding determines how much Medicare pays the hospital for the care given. A hospital may need to edit its coding for a variety of appropriate reasons, such as when the hospital identifies an omission or error. The BFCC-QIO confirms that the change to the coding accurately reflects the care described in the medical record, helping to make sure that Medicare is only paying the appropriate amount.
For more information, visit the QIO Program website.
What is Livanta’s role as a BFCC-QIO?
BFCC-QIOs help Medicare recipients to be sure your rights under Medicare have been met.
If you are a Medicare recipient, the QIO can help you:
Get immediate help in resolving a healthcare concern
Appeal a notice that you will be discharged from the hospital or other types of services will be discontinued
What other reviews does Livanta conduct?
Medical necessity reviews
Emergency Medical Treatment and Labor Act (EMTALA) reviews
Hospital-requested higher reimbursement reviews
Focused reviews on a specific topic or situation as determined by the Centers for Medicare & Medicaid Services (CMS)
Hospital short stay reviews, commonly known as Two Midnight Reviews
Is Livanta the only BFCC-QIO?
No. Livanta covers 19 states and U.S. territories. KEPRO
is the BFCC-QIO for the remaining states.
Are there QIOs that work with providers on quality improvement?
Yes. Quality Innovation Network (QIN) QIOs work with health care providers on quality improvement efforts that are focused on making care better for people on Medicare. QIN-QIOs work on reducing readmissions and hospital-acquired infections, medication safety, and diabetes and cardiac care. View a list of the Quality Innovation Network QIO contractors.
How long is the BFCC-QIO contract?
The current contract cycle for all QIOs runs from May 8, 2014 through May 7, 2019.