BFCC-QIO Appeal: How to File When Medicare Cuts Your Parent's Care

Your parent's home health agency just delivered a Notice of Medicare Non-Coverage saying skilled nursing visits end in two days. You have until noon tomorrow to file an appeal — and the form says to contact something called the "BFCC-QIO." Nobody at the agency explained what that is or how to reach them.

The Beneficiary and Family Centered Care Quality Improvement Organization is the independent body that reviews Medicare coverage disputes when care is ending or has been denied. Filing with them is the fastest path to keeping your parent's services running while the decision is reviewed.

Which QIO Covers Your State

Two national contractors divide the country between them:

Commence Health (formerly Livanta LLC, rebranded August 2025) covers CMS Regions 2, 3, 5, 7, and 9: American Samoa, Arizona, California, Delaware, District of Columbia, Guam, Hawaii, Illinois, Indiana, Iowa, Kansas, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, Northern Mariana Islands, Ohio, Pennsylvania, Puerto Rico, Virgin Islands, Virginia, West Virginia, and Wisconsin.

Acentra Health (formerly Kepro) covers CMS Regions 1, 4, 6, 8, and 10: Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Montana, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Wyoming.

The Expedited Appeal Timeline

When your parent receives a NOMNC (Notice of Medicare Non-Coverage) from a home health agency, SNF, or other provider, the clock starts immediately:

Day the NOMNC is delivered: You receive the notice at least two calendar days before covered services are scheduled to end, or on the second-to-last care visit if home health isn't provided daily.

Your deadline: Contact the BFCC-QIO by noon on the calendar day before the scheduled end of covered care. Call the regional helpline — do not mail or fax the request unless you've already called.

What happens if you call on time: The QIO accepts the case and the provider must continue services at the current level while the review is pending. Your parent is financially protected during this period — they cannot be billed for the disputed services.

What happens if you miss the deadline: You lose the fast-track review's automatic financial protection. You can still ask the BFCC-QIO to review the case or pursue another appeal, but different rules apply and you may be responsible for services after the coverage end date on the NOMNC.

What to Say When You Call

When you reach the QIO helpline, you'll need:

• Your parent's full name and Medicare Beneficiary Identifier (the number on their red, white, and blue Medicare card)
• The name and address of the provider ending care
• The date shown on the NOMNC for when services will end
• A brief statement of why you believe care should continue

You don't need medical records or clinical justification ready when you call. The QIO obtains clinical documentation directly from the provider after accepting the appeal. Your job is to make the request on time.

Say this: "I'm calling to request an expedited review of a coverage termination. My parent received a Notice of Medicare Non-Coverage on [date], and services are scheduled to end on [date]. I believe skilled care is still medically necessary because [brief reason — they still can't walk safely, their wound hasn't healed, they need ongoing PT for balance]."

What the QIO Reviews

After accepting your case, the QIO assigns a physician peer reviewer who examines the clinical records independently. The reviewer determines whether the provider's decision to end coverage was clinically appropriate based on Medicare coverage criteria.

The QIO must issue its decision within approximately 72 hours. Three possible outcomes:

• Coverage continues. The QIO agrees with you — services must continue and the provider cannot bill your parent for the disputed period.
• Coverage termination upheld. The QIO agrees with the provider. Your parent won't be responsible for services provided before the coverage end date on the NOMNC. If care continues after that date, they may have to pay for those services.
• Case referred for further review. In complex cases, the QIO may request additional documentation before issuing a final decision.

Beyond the QIO: Escalation Options

If the QIO upholds the termination and you still believe care should continue, you're not out of options. The next level is a reconsideration by a Qualified Independent Contractor (QIC), followed by an Administrative Law Judge hearing if the Amount in Controversy meets the 2026 threshold of $200. Federal court review requires at least $1,960 in controversy.

For most home health disputes, the QIO fast appeal is where the decision gets made. The key is making the call before the noon deadline.

The Medicare Home Health and Skilled Nursing Benefit guide provides QIO call scripts, a NOMNC response checklist, and appeal escalation templates for each level of the process.

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