Q&A: CMS changes scope of work for QIOs

Q: I read that CMS changed the scope of work for the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) Livanta and Kepro recently. What impact has that had on hospitals?

A: As the QIO change was rolled out this spring, case management departments were expected to update forms and notices and take other steps to comply with the changes by June 8. Case management directors should make sure that their hospitals have taken the following actions:

• Appeal notices must be updated if needed with the new QIO information on the Important Message and Detailed Notice, including QIO name, address, and phone number. Postacute providers need to update the notice of Medicare noncoverage form.
  • While waiting to have your updated appeal notices printed, you can use a sticker with the new QIO contact information.
• A new Memorandum of Agreement (MOA) and provider update form must be completed online for the appropriate QIO.
  • You’ll find a link to complete the new MOA on the home page of your QIO’s website.
• Remember that the hospital contact and phone number that you select must be available seven days a week, as discharge appeals can be reconciled on a weekend.
• Patients or patient family members will be referred to the correct QIO for processing their complaint if they call the wrong QIO. However, if the hospital provided the wrong QIO information to the patient, the hospital will be considered noncompliant.

Expect some differences in processes between Kepro and Livanta. Visiting their websites is valuable to understanding each QIOs’ approaches and changes. If you still have questions, it may be beneficial to contact the specific QIO resources to gain additional clarification. Accessing the BFCC-QIO Areas Map provides a view of state assignments as well.

For more information, see Case Management Monthly.