A Medicare Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) is referred to as a BFCC-QIO. It is an organization that reviews complaints, “quick appeals”, and quality of care issues for Medicare recipients. The “quick appeal” refers to the immediate review of discharge issues when a patient is receiving care in a hospital, nursing home, hospice, rehabilitation center, or through a home health agency.
The BFCC-QIO is the first appeal for Medicare recipients in hospital and non-hospital settings who believe their Medicare coverage is ending too soon. Recipients have a right to an immediate review by the BFCC-QIO, if they are being discharged from coverage. For example: if a Medicare patient is told by a hospital or skilled nursing facility she is being discharged, but she believes it is too soon, she can request a review of that decision by the BFCC-QIO. The patient or her representative must request the review as soon as she receives the discharge notice.
When a review is requested, the BFCC-QIO will review the discharge and make a decision within 72 hours of the request. During the review process, the patient will receive a “Detailed Notice of Discharge”. This notice includes information about the discharge. The BFCC-QIO will review your medical records and ask the patient’s opinion.
While the review is conducted, the patient may remain in the hospital or skilled nursing facility or continue to receive services. If the BFCC-QIO agrees with the patient, she is not discharged. Medicare coverage continues and the patient is only responsible for the co-payments and deductibles related to that spell of illness. If the BFCC-QIO disagrees with the patient, coverage ends and the patient is financially responsible for the services utilized after the decision. If the patient disagrees with the BFCC-QIO decision, she can appeal that decision.
To learn more about the BFCC-QIO that serves your state or region, read the notice called “An Important Message From Medicare about Your Rights.” This notice will list the name and contact information for the BFCC-QIO. It will also explain your rights for appealing a decision. For information about theappeal process visit www.Medicare.gov.