The Centers for Medicare & Medicaid Services (CMS) has made significant changes to its national Quality Improvement Organization (QIO) program. Under the new program structure, QIOs are not permitted to serve both the case review and quality improvement roles. The TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) has the health care quality improvement role and therefore is not participating in case review, referred to as Beneficiary and Family Centered Care (BFCC).
As of Aug. 1, 2014, health care providers and Medicare beneficiaries in Texas, Arkansas, Missouri and Oklahoma must contact the BFCC QIO KEPRO toll-free at 1-844-430-9504, and health care providers and Medicare beneficiaries in Puerto Rico must contact the BFCC QIO Livanta toll-free at 1-866-815-5440 for all appeal requests and quality of care concerns. All outstanding medical record requests should be mailed to:
Texas, Arkansas, Missouri and Oklahoma:
KEPRO Rock Run Center 5700 Lombardo Center, Suite 100 Seven Hills, Ohio 44131 Call toll-free at 1-844-430-9504
Livanta BFCC-QIO Program 9090, Junction Drive, Suite 10, Annapolis Junction, MD 20701
If you have any questions you can email CMS directly at QIOProgram@cms.hhs.gov. In addition, CMS is planning an Open Door Forum for providers. View more information about the changes to the QIO program.