Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) Review
Guidance for when a Medicare health plan, either directly or by delegation, terminates pre-authorized coverage of an inpatient hospital admission, or of Skilled Nursing Facility (SNF), Home Health Agency (HHA), or Comprehensive Outpatient Rehabilitation Facility (CORF) services, a special expedited review procedure applies. Expedited review requests filed timely bypass the health plan's reconsideration process, and an independent review entity known as a Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) performs the review.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 11, 2020
When a Medicare health plan, either directly or by delegation, terminates pre-authorized coverage of an inpatient hospital admission, or of Skilled Nursing Facility (SNF), Home Health Agency (HHA), or Comprehensive Outpatient Rehabilitation Facility (CORF) services, a special expedited review procedure applies. Expedited review requests filed timely bypass the health plan's reconsideration process, and an independent review entity known as a Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) performs the review.
If the deadline for requesting a BFCC-QIO review is missed, the enrollee or his or her representative may still ask the health plan for an expedited appeal.
For instructions on how to request a BFCC-QIO review, health plan enrollees should check their provider termination notice; or they may call 1-800-MEDICARE to find out how to contact their local BFCC-QIO.
For additional guidance, see section 100 in Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance in the "Downloads" section below.
Related notices and forms can be found on the "Notices and Forms" page, accessed using the left navigation menu on this page.
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