For Consumers

Important Information For Medicare Beneficiaries

Changes Effective August 1, 2014

Overview of Transition

  • In the past QIOs like IPRO assisted Medicare beneficiaries and families by reviewing whether seniors were ready for discharge from a hospital or home health agencies, whether a health care service should be ended or whether a patient should have been transferred from an Emergency Department to another hospital or to home. They were also available to review a quality of care concern.
  • Medicare has made some changes to the program to ensure that your needs are better met by designating a special QIO just to address beneficiary and family concerns.
  • The Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) will be the QIO that will manage all beneficiary complaints and quality of care reviews to ensure consistency in the case review process while taking into consideration local factors important to you and your family.
  • Quality Innovation Network (QIN) QIOs like IPRO’s Atlantic Quality Innovation Network are responsible for working with providers and the community on multiple, data-driven quality initiatives to improve patient safety, reduce harm, and improve clinical care at their local and regional levels.

Quality Case Review and Appeals after July 31st

  • Effective August 1, 2014, all beneficiary quality review case work and appeals will be conducted by the new Beneficiary and Family Centered Care (BFCC-QIO) Livanta. (Review work will no longer be done by IPRO)
  • These changes are part of the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization (QIO) program transformation effort to further enhance the quality of services to Medicare beneficiaries.
  • If IPRO has your case currently under review or in process, please be assured that every effort has been made to ensure a seamless transition for Medicare beneficiaries with no disruption in case review services.

Maintaining Local Presence

  • QIOs will continue to work with doctors and nurses in your communities, but will not be limited to state boundaries in ensuring quality of care.
  • QIOs are expected to have knowledge of the things that may be important to the people in the area in which you live such as culture, practices, and healthcare improvement needs, and will apply that knowledge to its case review and quality improvement projects.

Contact Information

  • A list of the current BFCC-QIOs and QIN-QIOs for your area, and their contact information, are located at QIOProgram.org.
  • More information on the QIO Program can be found at QIOProgram.org or by contacting 1-800-MEDICARE.

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