If You Have Medicare

Quality Improvement Organizations (QIOs) are organizations that are available to assist you when you have questions about whether you are ready for discharge from a hospital or home health agencies, whether a health care service should be ended or whether you should have been transferred from an Emergency Department to another hospital or to home. They also are available to review a quality of care concern that you or your family may have about the care that you receive from your hospital, doctor, nurse or others.

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. There will be a second QIO that will work with hospitals and doctors to help them with their quality improvement activities.

The Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) manages 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 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.

  • Beginning Friday, Aug.1, 2014, all Tennessee beneficiary quality review case work and appeals will be conducted by the new Beneficiary and Family Centered Care (BFCC-QIO) KEPRO. On that date, Medicare beneficiaries must contact KEPRO toll-free at 1-844-430-9504 for all appeal requests and Quality of Care concerns.
  • 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 your case is 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.

Ask Medicare

Are you the caregiver of a Medicare beneficiary? Do you have questions about your loved one’s Medicare coverage, billing or care? Ask Medicare can help! At http://www.medicare.gov/caregivers you can find answers to all of your Medicare questions including:

  • How to obtain permission to access your loved one’s health information
  • What services are covered by Medicare
  • How to plan for long-term care
  • Where to find financial, legal and local help