New Case Review Organization to Process Medicare Termination Notices

The Centers for Medicare and Medicaid Services (CMS) has awarded the Medicare case review function to the new regional Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), Livanta, LLC, effective Aug. 1, 2014. CMS has decided to separate the Quality Improvement Organization (QIO) function from the case review process, both of which were previously administered by IPRO. CMS is also moving to a structure whereby the case review function is managed on a regional basis instead of by the State. Therefore, Livanta will be covering an area that includes the northeast, Puerto Rico and the Virgin Islands, whereas IPRO only covered New York. 

In a recent press release, CMS launches improved Quality Improvement Program, CMS noted that they are seeking “to restructure the QIO Program to gain efficiencies, to eliminate any perceived conflicts of interest and to better address the needs of Medicare beneficiaries using BFCC-QIOs to focus on providing patients a voice through conducting quality of care reviews, discharge and termination of service appeals and other areas of required review in various provider settings.” IPRO has also posted a notice on their website.

Among the new services to be administered by Livanta is the expedited review process for the termination of Medicare services. This will impact both nursing homes and home health agencies. Impacted providers should have received a notice direct from Livanta instructing them on how to complete the necessary memorandum of understanding. The notice also has the new contact information for expedited review processing. For member convenience, a copy of the Livanta letter can be viewed by clicking here. Providers should also be updating contact information provided to beneficiaries as listed in the Livanta letter.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827