BFCC QIO Program
Quality Improvement Organization Program Overview
The Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) Program, one of the largest federal programs dedicated to improving health quality for Medicare beneficiaries, is an integral part of the U.S. Department of Health and Human Services’ National Quality Strategy for providing better care and better health at lower cost. By law, the mission of the BFCC-QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. Based on this statutory charge and the Centers for Medicare and Medicaid Services’ (CMS) program experience, CMS identifies the core functions of the BFCC-QIO Program as:
- Improving quality of care for beneficiaries;
- Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for goods and services that are reasonable, necessary, and are provided in the most appropriate setting; and
- Protecting beneficiaries by expeditiously addressing individual complaints such as beneficiary complaints, provider-based notice appeals, violations of the Emergency Medical Treatment and Labor Act (EMTALA), and other related responsibilities as articulated in QIO-related law.
Locate Your QIO
The purpose of the BFCC-QIO Program is to improve health care services for Medicare beneficiaries through performing statutory review functions. CMS and the BFCC-QIOs ensure that care provided by the Medicare Program is medically necessary, reasonable, meets professionally recognized standards of care, is provided in the appropriate setting, and complies with certain standards under the Emergency Medical Treatment and Labor Act. Two BFCC-QIOs, Livanta and Kepro, serve all 50 states and three territories.
National Coordinating Oversight and Review Center
The Beneficiary and Family Centered Care National Coordinating Oversight and Review Center (BFCC NCORC) supports BFCC-QIOs as they work to improve health care services for Medicare beneficiaries and their families.
BFCC NCORC initiatives include:
- Ensuring beneficiary case reviews are efficient, thorough, and systematic;
- Using national data to identify areas for increased patient safety and quality improvement;
- Collaborating with the Centers for Medicare & Medicaid Services (CMS) and other partners to support the rights and services for Medicare beneficiaries;
- Engaging beneficiaries and their families to improve how health care is delivered; and
- Raising awareness about beneficiary rights under the Medicare program.
The BFCC NCORC regularly works with beneficiaries and their families to gather input about how to improve the care and services delivered under the BFCC-QIO program.