Beneficiary experiences give the Quality Improvement Organization (QIO) Program the ability to identify opportunities for improvement, create solutions that address the needs of real stakeholders, and encourage action from the healthcare system. As such, beneficiaries and/or their families/caregivers are encouraged to submit complaints if they have concerns about the quality of care received, or to appeal a healthcare provider’s decision to discontinue services or order discharge from the hospital. By sharing your experiences and concerns, you make it possible to improve the healthcare system for yourself and for other patients. Engaging with your Beneficiary and Family Centered Care (BFCC) QIO also allows you to access resources to empower yourself in your or your loved one’s healthcare decisions.

Visit the Beneficiary Care Management Program (BCMP) website if you need assistance with reviewing discharge instructions and post-treatment plans; coordinating follow-up care with primary care physicians and/or other providers; or obtaining referrals to community resources or person and family engagement (PFE) partners. The BCMP website also provides helpful tips and resources about talking to your doctor, staying healthy, and managing your healthcare.


Right to Appeal

As a Medicare beneficiary and/or their family member/caregiver, you can file an appeal with your BFCC-QIO if you do not agree with a healthcare provider’s decision to send you/your loved one home from the hospital, or if you do not agree with their decision to discontinue services. If you have already filed an appeal and would like help with discharge instructions, follow-up care, or community resources, the BCMP can help!

Additional information about filing an appeal can be found at Medicare.gov. You may also wish to contact Medicare directly if you have concerns about a coverage or payment decision made by Medicare, a Medicare health plan, or a Medicare Prescription Drug Plan.


Right to File a Quality of Care Concern

As a Medicare beneficiary and/or their family member/caregiver, you can also file a quality of care complaint directly with your regional BFCC-QIO if you have concerns about the quality of care that you or your loved one received. You can call your regional BFCC-QIO to discuss your complaint, and they will mail you a Medicare quality of care complaint form. You can also access the form online by clicking here. Completed forms must be mailed or faxed to your BFCC-QIO (emailed forms are not accepted). Please note that traditional complaint reviews can take up to 30 days or more.

Additional information about filing a quality of care complaint can be found at Medicare.gov. You may also contact Medicare at 1-800-MEDICARE if you have general questions about Medicare coverage, need information about how to enroll in Medicare, or want to discuss billing issues.

To find your regional BFCC-QIO, click here and search for your state under Beneficiary and Family Centered Care QIOs.

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