When a Medicare health plan, either directly or by delegation, terminates pre-authorized coverage of an inpatient hospital admission, or of Skilled Nursing Facility (SNF), Home Health Agency (HHA), or Comprehensive Outpatient Rehabilitation Facility (CORF) services, a special expedited review procedure applies. Expedited review requests filed timely bypass the health plan's reconsideration process, and an independent review entity known as a Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) performs the review.
If the deadline for requesting a BFCC-QIO review is missed, the enrollee or his or her representative may still ask the health plan for an expedited appeal.
For instructions on how to request a BFCC-QIO review, health plan enrollees should check their provider termination notice; or they may call 1-800-MEDICARE to find out how to contact their local BFCC-QIO.
For additional guidance, see section 100 in Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance in the "Downloads" section below.
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