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Medicare QIO 2026: How Quality Improvement Organizations Protect Your Rights

## **Important Disclaimer:** *This information is for educational purposes only and does not constitute marketing of any specific Medicare plan. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. This material is not affiliated with or endorsed by the federal Medicare program.*

**Quality Improvement Organizations (QIOs) 2026: Your Medicare Advocate**

**Quick Answer:** A Quality Improvement Organization (QIO) is an independent organization Medicare contracts with to protect beneficiaries' rights and care quality. As of 2026, two national Beneficiary and Family Centered Care QIOs—**Acentra Health** (formerly Kepro) and **Commence Health** (formerly Livanta)—handle discharge appeals and quality-of-care complaints, divided by region. If a hospital says you're being discharged too soon, you can call your BFCC-QIO for a free, fast appeal and stay covered while they review your case.

When you have concerns about the quality of care you're receiving from Medicare providers, or when you disagree with discharge decisions from hospitals or skilled nursing facilities, there's a powerful advocate on your side that many Medicare beneficiaries don't know about: Quality Improvement Organizations, or QIOs.

QIOs are independent organizations contracted by Medicare to ensure beneficiaries receive high-quality care and to protect your rights as a Medicare patient. Understanding what QIOs do and how they can help you could make the difference between accepting poor care and getting the quality treatment you deserve.

**What Are Quality Improvement Organizations (QIOs)?**

Quality Improvement Organizations are independent organizations that Medicare contracts with to:

• **Monitor the quality of care** provided to Medicare beneficiaries
• **Review cases** of potential poor quality or inappropriate care
• **Handle beneficiary complaints** about care quality
• **Investigate premature discharge** decisions
• **Work with healthcare providers** to improve care quality

Rather than one organization per state, Medicare now contracts with **two national BFCC-QIO companies**—Acentra Health and Commence Health—that split the country into regions. Every state, territory, and the District of Columbia is assigned to one of them based on where you received care.

**Two Types of QIOs**

**Beneficiary and Family Centered Care QIOs (BFCC-QIOs)**

These QIOs focus directly on beneficiary services and are the ones you'll actually contact:

• **Handle immediate complaints** about care quality and premature discharge
• **Conduct case reviews** when beneficiaries have concerns
• **Provide information** about your rights as a Medicare patient
• **Offer immediate advocacy** for urgent situations

As of 2026, the two BFCC-QIOs are **Acentra Health** (formerly Kepro) and **Commence Health** (formerly Livanta). The one you call depends on the region where you received care.

**Quality Innovation Network QIOs (QIN-QIOs)**

These QIOs work on broader quality improvement behind the scenes—you typically won't interact with them directly:

• **Collaborate with healthcare providers** to improve care
• **Implement quality improvement initiatives**
• **Analyze data** to identify care improvement opportunities
• **Work on population health** improvements

**Services QIOs Provide to Beneficiaries**

**Quality of Care Reviews**

QIOs can investigate concerns about:

• **Poor quality medical care** you received while covered by Medicare
• **Inappropriate treatment decisions** by your healthcare providers
• **Lack of proper medical attention** in hospitals or other facilities
• **Concerns about provider competence** or care standards

**Premature Discharge Reviews**

QIOs can help when you believe you're being discharged too soon from:

• **Hospitals**
• **Skilled nursing facilities**
• **Home health agencies**
• **Hospice care**
• **Comprehensive Outpatient Rehabilitation Facilities (CORFs)**

**Hospital Discharge Planning**

QIOs can review whether:

• **Discharge planning** was appropriate for your condition
• **Proper arrangements** were made for continuing care
• **You were ready** for discharge based on your medical condition
• **Alternative care settings** were properly considered

**When to Contact Your QIO**

**Quality of Care Concerns**

Contact your QIO if you experience:

• **Inadequate pain management** during a hospital stay
• **Infections acquired** during healthcare treatment
• **Medication errors** or inappropriate medication management
• **Delayed or improper treatment** for serious conditions
• **Poor communication** about your condition or treatment

**Premature Discharge Situations**

Call your QIO immediately if:

• **You're being discharged** and don't feel ready to leave
• **Your condition hasn't improved** enough for safe discharge
• **No proper discharge planning** has been done
• **You haven't been informed** about continuing care needs
• **You feel unsafe** about leaving the facility

**Access to Care Issues**

QIOs can help with:

• **Difficulty getting appointments** with Medicare providers
• **Providers refusing** to treat Medicare patients
• **Discrimination** based on Medicare coverage
• **Emergency department** treatment concerns

**How to Contact Your QIO**

**Finding Your Local QIO**

You can find your QIO contact information through:

• **Medicare.gov**: Search for "QIO" and your state
• **Your Medicare Summary Notice (MSN)**: QIO contact information is printed on your MSN
• **Calling 1-800-MEDICARE**: They can connect you directly to the correct QIO for your region
• **The Acentra Health website (acentraqio.com) or Commence Health website**: To confirm which contractor serves your state
• **Hospital and healthcare facility notices**: QIOs are required to be listed on important notices like "An Important Message from Medicare"

**Multiple Ways to Contact**

Most QIOs offer several contact methods:

• **Toll-free regional helplines** for immediate assistance
• **Online complaint and appeal forms** for non-urgent issues
• **Written complaints** by mail or fax
• **Around-the-clock voicemail** for urgent discharge situations

**Information to Have Ready**

When contacting your QIO, be prepared with:

• **Your Medicare number**
• **Dates of service** you're concerned about
• **Names of providers** involved in your care
• **Specific details** about your concerns
• **Supporting documentation** if available

**The QIO Review Process**

**Initial Assessment**

When you contact a QIO:

• **Intake specialists** will gather basic information about your concern
• **Priority determination** is made based on urgency and type of issue
• **Case assignment** to appropriate review staff
• **Timeline establishment** for investigation and resolution

**Immediate Review for Discharge Issues (Fast Appeals)**

For premature discharge concerns, you have the right to a **fast appeal**. Here's how it works:

• You'll be given a notice called **"An Important Message from Medicare"** within two days of admission, explaining your appeal rights and the QIO's phone number
• If you request a fast appeal **by the day you're scheduled to be discharged**, you can stay in the hospital while you wait for the decision—and you won't have to pay for the stay except for applicable coinsurance or deductibles
• The hospital will provide a **"Detailed Notice of Discharge"** by noon the day after the QIO notifies them
• The QIO's doctors review your medical record and typically decide **within one day** of receiving the information they need

**Quality of Care Investigations**

For care quality concerns:

• **Medical record collection** from involved providers
• **Review by medical professionals** with relevant expertise
• **Provider contact** for additional information if needed
• **Written findings** provided to you within specified timeframes

**What QIOs Can Do for You**

**Immediate Interventions**

QIOs have the authority to:

• **Stop premature discharges** when medically inappropriate
• **Require providers** to continue necessary care
• **Facilitate communication** between you and your providers
• **Connect you with other resources** for ongoing care needs

**Quality Improvement Actions**

Based on their reviews, QIOs can:

• **Require provider education** on proper care standards
• **Implement corrective action plans** at healthcare facilities
• **Monitor provider performance** over time
• **Report serious issues** to licensing boards or Medicare

**Beneficiary Education and Support**

QIOs also provide:

• **Information about your rights** as a Medicare patient
• **Education about quality care standards**
• **Resources for finding** quality healthcare providers
• **Guidance on navigating** the healthcare system

**Your Rights During QIO Reviews**

**Confidentiality Protections**

QIO reviews are:

• **Confidential** - your identity is protected in most cases
• **Protected from retaliation** - providers cannot take action against you for filing complaints
• **Independent** - QIOs are separate from healthcare providers and Medicare

**Appeal Rights**

If you disagree with QIO decisions:

• **You can appeal** certain QIO determinations
• **Administrative review** is available for some decisions
• **Additional advocacy resources** may be available through other organizations

**Right to Information**

You have the right to:

• **Receive written findings** from QIO reviews
• **Understand the basis** for QIO decisions
• **Get copies** of relevant QIO correspondence (including materials sent to the BFCC-QIO)
• **Know what actions** were taken based on their review

**Common QIO Success Stories**

**Premature Hospital Discharge**

Maria was being discharged from the hospital after hip surgery even though she couldn't safely walk or care for herself. Her daughter contacted the QIO, which reviewed Maria's case and determined she needed additional recovery time. The hospital was required to continue her care until she was medically ready for discharge.

**Quality of Care in Skilled Nursing**

Robert's family was concerned about medication errors and poor hygiene care at his skilled nursing facility. The QIO investigated and found multiple care deficiencies. The facility was required to implement a corrective action plan and provide additional staff training.

**Delayed Emergency Treatment**

Susan waited six hours in an emergency room with chest pain before being seen by a doctor. The QIO review found the delay was inappropriate and worked with the hospital to improve their emergency department triage procedures.

**QIO Limitations**

**What QIOs Cannot Do**

QIOs cannot:

• **Provide financial compensation** for poor care
• **Reverse medical decisions** that were within appropriate standards
• **Force providers** to provide specific treatments
• **Act as your personal healthcare advocate** for routine matters

**Other Resources for Issues QIOs Can't Handle**

For issues outside QIO authority:

• **Medicare Administrative Contractors (MACs)** for billing and coverage disputes
• **State licensing boards** for provider licensing issues
• **Legal counsel** for malpractice concerns
• **Patient advocacy organizations** for ongoing support

**Special QIO Programs**

**Case Review for Vulnerable Populations**

QIOs pay special attention to:

• **Nursing home residents** and their care quality
• **Beneficiaries with disabilities** and accessibility issues
• **Rural beneficiaries** who may have limited provider options
• **Dual-eligible beneficiaries** with both Medicare and Medicaid

**Quality Improvement Initiatives**

QIOs work on broader improvements in:

• **Hospital-acquired infections** prevention
• **Medication safety** in healthcare facilities
• **Care transitions** between different healthcare settings
• **Preventive care** delivery and coordination

**Working Effectively with Your QIO**

**Be Specific About Your Concerns**

When contacting your QIO:

• **Provide detailed information** about what went wrong
• **Focus on care quality issues** rather than general dissatisfaction
• **Document specific dates, times, and people** involved
• **Explain how the poor care** affected your health or safety

**Keep Records**

Maintain documentation of:

• **All contact** with your QIO
• **Medical records** related to your concern
• **Correspondence** from providers about the issue
• **Any changes** in your care following QIO involvement

**Follow Up**

After filing a QIO complaint:

• **Stay engaged** in the review process
• **Provide additional information** if requested
• **Keep your contact information** updated with the QIO
• **Ask questions** if you don't understand the process or findings

**The Future of QIOs**

**Technology and Data Analytics**

QIOs are increasingly using:

• **Electronic health records** for more efficient reviews
• **Data analytics** to identify quality trends
• **Patient safety databases** to track improvement efforts
• **Telehealth capabilities** for remote consultations

**Enhanced Coordination**

Modern QIO programs focus on:

• **Better coordination** with other Medicare contractors
• **Improved communication** with beneficiaries
• **Faster response times** for urgent issues
• **More proactive** quality improvement efforts

**How QIOs Improve Medicare for Everyone**

**Systemic Improvements**

Through their work, QIOs contribute to:

• **Higher quality care** across the Medicare system
• **Better provider education** about quality standards
• **Improved patient safety** in healthcare facilities
• **Enhanced beneficiary awareness** of their rights

**Your Role in Quality Improvement**

By contacting QIOs when you have concerns, you help:

• **Identify quality problems** that need attention
• **Protect other beneficiaries** from similar issues
• **Improve overall care** in your community
• **Hold providers accountable** for quality standards

**Frequently Asked Questions**

**Who are the Medicare QIOs in 2026?**

As of 2026, there are two national Beneficiary and Family Centered Care QIOs (BFCC-QIOs): **Acentra Health** (formerly Kepro) and **Commence Health** (formerly Livanta, which rebranded in August 2025). They divide the country into regions, and the one you contact depends on where you received care.

**How do I contact my QIO?**

You can find your QIO's regional helpline on "An Important Message from Medicare" notice given to you at the hospital, on your Medicare Summary Notice, by calling 1-800-MEDICARE, or on the Acentra Health (acentraqio.com) and Commence Health websites. Call the number for the region where you received care, not necessarily where you live.

**What is a fast appeal and will I have to pay while I wait?**

A fast appeal lets an independent BFCC-QIO decide whether your Medicare-covered services should continue when you think you're being discharged too soon. If you request it by your scheduled discharge day, you can stay in the hospital during the review and won't have to pay for that stay except for applicable coinsurance or deductibles.

**What can a QIO NOT do?**

QIOs cannot provide financial compensation for poor care, reverse medical decisions that met appropriate standards, force a provider to deliver a specific treatment, or act as your personal advocate for routine matters. For billing disputes, contact your Medicare Administrative Contractor (MAC); for malpractice, consult legal counsel.

**Is contacting a QIO confidential?**

Yes. QIO reviews are confidential, your identity is protected in most cases, and providers are prohibited from retaliating against you for filing a complaint or appeal.

**Don't Hesitate to Use This Important Resource**

Quality Improvement Organizations exist specifically to protect your rights and ensure you receive quality care as a Medicare beneficiary. If you're experiencing problems with your healthcare, don't suffer in silence – your QIO is there to help.

Remember that QIOs have real authority to investigate concerns and require improvements in care. They're not just complaint departments – they're your advocates for quality healthcare.

**Need Additional Help?**

To contact your local QIO or learn more about quality of care rights:

• Visit Medicare.gov and search for "QIO" plus your state name
• Call 1-800-MEDICARE to be connected to the correct QIO for your region
• Look for QIO contact information on your Medicare Summary Notice or "An Important Message from Medicare"
• Contact your local State Health Insurance Program (SHIP) for additional guidance

**Required Compliance Disclaimers:**

*For agent use only. Not affiliated with the U.S. federal government or federal Medicare program. This information is provided for educational purposes only and does not constitute marketing of any specific Medicare plan.*

*For official Medicare information, please visit Medicare.gov or call 1-800-MEDICARE. You can also contact your local State Health Insurance Program (SHIP) for personalized assistance.*