D4 Annual Report Template

AREA #1 BFCC-QIO 11TH SOW

ANNUAL MEDICAL SERVICES REPORT08/01/2015 - 07/31/2016

BFCC-QIO 11th

SOW Annual Medical Services Report

08/01/2015 – 07/31/2016

TABLE OF CONTENTS TABLE OF CONTENTS ........................................................................................................................................................................... 2

INTRODUCTION: .................................................................................................................................................................................... 1

Livanta QIO Area #1 – Summary ......................................................................................................................................................... 2

1) Total # of Reviews................................................................................................................................................................ 2

2) Top 10 Principal Medical Diagnoses:................................................................................................................................... 3

3) Provider Reviews Settings: ................................................................................................................................................... 4

4) Quality of Care Concerns Confirmed ................................................................................................................................... 5

5) Discharge/Service Termination ............................................................................................................................................ 6

6) Beneficiary Appeals of Provider Discharge/Service Terminations and Denials of Hospital Admissions Outcomes by

Notification Type ................................................................................................................................................................. 8

7) Evidence Used in Decision-Making ..................................................................................................................................... 9

8) Reviews by Geographic Area ............................................................................................................................................. 13

9) Outreach and Collaboration with Beneficiaries .................................................................................................................. 14

10) Immediate Advocacy Reviews ........................................................................................................................................... 16

11) Example/Success Story ...................................................................................................................................................... 17

12) Beneficiary Helpline Statistics ........................................................................................................................................... 17

CONCLUSION: ....................................................................................................................................................................................... 18

APPENDIX .............................................................................................................................................................................................. 19

Livanta QIO Area #1 – State of Connecticut ...................................................................................................................................... 19

1) Total # of Reviews.............................................................................................................................................................. 19

2) Top 10 Principal Medical Diagnoses .................................................................................................................................. 20

3) Beneficiary Demographics ................................................................................................................................................. 20

4) Provider Reviews Settings .................................................................................................................................................. 21

5) Quality of Care Concerns Confirmed ................................................................................................................................. 22


Notification Type ............................................................................................................................................................... 24

7) Reviews by Geographic Area – Urban and Rural ............................................................................................................... 25


Livanta QIO Area #1 – State of Massachusetts................................................................................................................................... 26

1) Total # of Reviews.............................................................................................................................................................. 26







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Livanta QIO Area #1 – State of Maine ............................................................................................................................................... 33

1) Total # of Reviews.............................................................................................................................................................. 33









Livanta QIO Area #1 – State of New Hampshire ................................................................................................................................ 41

9) Total # of Reviews.............................................................................................................................................................. 41









Livanta QIO Area #1 – State of New Jersey ....................................................................................................................................... 48

1) Total # of Reviews.............................................................................................................................................................. 48









Livanta QIO Area #1 – State of New York ......................................................................................................................................... 56

1) Total # of Reviews.............................................................................................................................................................. 56




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Livanta QIO Area #1 – State of Pennsylvania .................................................................................................................................... 63

1) Total # of Reviews.............................................................................................................................................................. 63






Notification Type. .............................................................................................................................................................. 69



Livanta QIO Area #1 – Puerto Rico .................................................................................................................................................... 71

1) Total # of Reviews.............................................................................................................................................................. 71









Livanta QIO Area #1 – State of Rhode Island .................................................................................................................................... 79

1) Total # of Reviews.............................................................................................................................................................. 79









Livanta QIO Area #1 – US Virgin Islands .......................................................................................................................................... 86

1) Total # of Reviews.............................................................................................................................................................. 86


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Livanta QIO Area #1 – State of Vermont ........................................................................................................................................... 93

1) Total # of Reviews.............................................................................................................................................................. 93







7) Reviews by Geographic Area – Urban and Rural ............................................................................................................. 100

8) Immediate Advocacy Reviews ......................................................................................................................................... 100

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INTRODUCTION: Livanta LLC is the Centers for Medicare & Medicaid Services (CMS) designated Beneficiary and Family

Centered Care Quality Improvement Organization (BFCC-QIO) for Area 1, which includes the states of

Connecticut, Massachusetts, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and

Vermont, as well as Puerto Rico and the US Virgin Islands.

The QIO Program, one of the largest federal programs dedicated to improving health quality for Medicare

beneficiaries, is an integral part of the U.S. Department of Health and Human (HHS) Services’ National Quality

Strategy for providing better care and better health at lower cost. By law, the mission of the QIO Program is to

improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.

CMS identifies the core functions of the QIO Program as:

• Improving quality of care for beneficiaries;

• Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services

and goods that are reasonable and necessary and that are provided in the most appropriate setting;

and

• Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary

complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and

Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.

BFCC-QIOs improve healthcare services and protect beneficiaries through expeditious statutory review

functions, including complaints and quality of care reviews for people with Medicare. The BFCC-QIO ensures

consistency in the case review process while taking into consideration local factors and local needs for general

quality of care, medical necessity, and readmissions.1

This annual report provides data regarding case reviews that were completed on behalf of Medicare

beneficiaries and their representatives, health care providers, and CMS for the date range of August 1, 2015

through July 31, 2016. Readers will find the overall Area 1 data in the first 12 sections of this report, and state-

specific data in the Appendix section of the report. This report underscores our commitment to transparency by

providing key performance metrics from the second year of Livanta’s work with Medicare beneficiaries.

Livanta understands and respects beneficiaries’ rights and concerns, and we are dedicated to protecting patients

by reviewing appeals and quality complaints in an effective and efficient patient-centered manner. For more

information on Livanta’s performance metrics, please visit our online dashboard.

1“Quality Improvement Organizations.” CMS.gov. Centers for Medicare & Medicaid Services. September 12, 2016. Web. September

29, 2016.

http://www.bfccqioarea1.com/dashboard.html

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LIVANTA QIO AREA #1 – SUMMARY

1) TOTAL # OF REVIEWS

Livanta completed reviews on behalf of Medicare beneficiaries receiving care in Area 1. This table breaks out

the number of reviews by the different types of reviews we conducted.

Review Type # of Reviews Percent of TOTAL

Reviews (%)

Coding Validation (120 - HWDRG)2 8,304 10.82%

Coding Validation (All Other Selection Reasons)2 15 0.02%

Quality of Care Review (101 through 104 - Beneficiary Complaint) 1,105 1.44%

Quality of Care Review (All Other Selection Reasons) 468 0.62%

Utilization (158 - FI/MAC Referral for Readmission Review) 0 0.00%

Utilization (All Other Selection Reasons) 20,419 26.62%

Notice of Non-coverage (105 through 108 - Admission and

Preadmission) 1,192 1.55%

Notice of Non-coverage (118 - BIPA) 13,911 18.13%

Notice of Non-coverage (117 - Grijalva) 23,357 30.45%

Notice of Non-coverage (121 through 124 - Weichardt) 7,819 10.19%

Notice of Non-coverage (111-Request for QIO Concurrence) 78 0.10%

Emergency Medical Treatment & Labor Act (EMTALA) 5 Day 3 46 0.06%

EMTALA 60 Day3 0 0.00%

Total 76,714 100.00%

2 Coding Validations and Utilization Reviews: Livanta reviews medical records to verify that the coding is accurate, that the care provided was

medically necessary, and that the care provided was delivered in the most appropriate setting. Certain hospital claims submitted as part of hospital

billing trigger reviews by Livanta, as the proposed changes to billing codes would allow the hospital to receive more money for the care delivered.

Currently, CMS refers all claims of this type in Area 1 to Livanta for review. We ensure that the care provided accurately matches the provider’s

claim for payment, and that the claim was coded correctly for billing purposes.

3 EMTALA Reviews: Livanta reviews cases that may be in violation of the Emergency Medical Treatment and Labor Act (EMTALA). EMTALA is a

federal law requiring that patients who need stabilization for an emergency medical condition receive that care, regardless of their ability to pay.

CMS refers cases of this kind to Livanta in Area 1 on an as-needed basis. We determine whether the medical screening was adequate, whether an

emergency medical condition existed, and if so, whether the patient was stabilized before a transfer. We also review the quality of care provided.

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2) TOP 10 PRINCIPAL MEDICAL DIAGNOSES:

This table provides information regarding the top 10 medical diagnoses for inpatient claims billed during the

annual reporting period for Medicare patients in Area 1.

Top 10 Medical Diagnoses # of Beneficiaries Percent of Beneficiaries (%)

1. A419 - SEPSIS, UNSPECIFIED

ORGANISM 83,369 20.86%

2. 0389 - SEPTICEMIA NOS 70,869 17.73%

3. J189 - PNEUMONIA,

UNSPECIFIED ORGANISM 39,369 9.85%

4. 486 - PNEUMONIA,

ORGANISM NOS 34,795 8.70%

5. J441 - CHRONIC

OBSTRUCTIVE PULMONARY

DISEASE W (ACUTE)

EXACERBATION

32,490 8.13%

6. N179 - ACUTE KIDNEY

FAILURE, UNSPECIFIED 30,453 7.62%

7. N390 - URINARY TRACT

INFECTION, SITE NOT

SPECIFIED

27,953 6.99%

8. I214 - NON-ST ELEVATION

(NSTEMI) MYOCARDIAL

INFARCTION

27,374 6.85%

9. 5849 - ACUTE KIDNEY

FAILURE NOS 27,003 6.76%

10. 5990 - URINARY TRACT

INFECTION NOS 26,047 6.52%

Total 399,722 100.00%

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3) PROVIDER REVIEWS SETTINGS:

This table provides information on the count and percent by setting for Health Service Providers (HSPs)

associated with a completed BFCC-QIO review in Area 1.

Setting # of Providers Percent of Providers

(%)

0: Acute Care Unit of an Inpatient Facility 538 15.84%

1: Distinct Psychiatric Facility 28 0.82%

2: Distinct Rehabilitation Facility 44 1.30%

3: Distinct Skilled Nursing Facility 2,182 64.25%

5: Clinic 0 0.00%

6: Distinct Dialysis Center Facility 3 0.09%

7: Dialysis Center Unit of Inpatient Facility 2 0.06%

8: Independent Based RHC 0 0.00%

9: Provider Based RHC 0 0.00%

C: Free Standing Ambulatory Surgery Center 4 0.12%

G: End Stage Renal Disease Unit 6 0.18%

H: Home Health Agency 292 8.60%

N: Critical Access Hospital 31 0.91%

O: Setting Does Not Fit Into Any Other Existing Setting

Code 0 0.00%

Q: Long Term Care Facility 42 1.24%

R: Hospice 209 6.15%

S: Psychiatric Unit of an Inpatient Facility 6 0.18%

T: Rehabilitation Unit of an Inpatient Facility 4 0.12%

U: Swing Bed Hospital Designation for Short-Term, Long-

Term Care, and Rehabilitation Hospitals 2 0.06%

Y: Federally Qualified Health Centers 3 0.09%

Z: Swing Bed Designation for Critical Access Hospitals 0 0.00%

Other 0 0.00%

Total 3,396 100.00%

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4) QUALITY OF CARE CONCERNS CONFIRMED

This table provides the number of confirmed quality of care concerns as identified by Physician Reviewer

Assessment Form (PRAF) category codes within the CMS Case Review Information System (CRIS). These

quality of care concerns are confirmed by Livanta’s independent physician reviewers as care that did not meet

the professionally recognized standards of medical care. Confirmed quality of care concerns are provided

education and referred as appropriate to the CMS designated Quality Innovation Network Quality Improvement

Organization (QIN-QIO) contractors who work with providers to make improvements in patient care.

Quality of Care (“C” Category) PRAF

Category Codes

# of

Concerns

# of

Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives

(QII)

C01: Apparently did not obtain pertinent history

and/or findings from examination 10 1 10.00% 2

C02: Apparently did not make appropriate

diagnoses and/or assessments 330 39 11.82% 23

C03: Apparently did not establish and/or develop

an appropriate treatment plan for a defined

problem or diagnosis which prompted this

episode of care [excludes laboratory and/or

imaging (see C06 or C09) and procedures (see

C07 or C08) and consultations (see C13 and

C14)

981 79 8.05% 5

C04: Apparently did not carry out an established

plan in a competent and/or timely fashion 306 34 11.11% 16

C05: Apparently did not appropriately assess

and/or act on changes in clinical/other status

results

163 15 9.20% 1

C06: Apparently did not appropriately assess

and/or act on laboratory tests or imaging study

results

39 11 28.21% 10

C07: Apparently did not establish adequate

clinical justification for a procedure which

carries patient risk and was performed

52 13 25.00% 0

C08: Apparently did not perform a procedure

that was indicated (other than laboratory and

imaging, see C09)

41 9 21.95% 1

C09: Apparently did not obtain appropriate

laboratory tests and/or imaging studies 107 12 11.21% 0

C10: Apparently did not develop and initiate

appropriate discharge, follow-up, and/or

rehabilitation plans

196 18 9.18% 11

C11: Apparently did not demonstrate that the 310 23 7.42% 2

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Category Codes

# of

Concerns

# of

Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives

(QII)

patient was ready for discharge

C12: Apparently did not provide appropriate

personnel and/or resources 2 1 50.00% 0

C13: Apparently did not order appropriate

specialty consultation 84 7 8.33% 3

C14: Apparently specialty consultation process

was not completed in a timely manner 20 3 15.00% 3

C15: Apparently did not effectively coordinate

across disciplines 53 8 15.09% 5

C16: Apparently did not ensure a safe

environment (medication errors, falls, pressure

ulcers, transfusion reactions, nosocomial

infection)

364 40 10.99% 10

C17: Apparently did not order/follow evidence-

based practices 52 7 13.46% 5

C18: Apparently did not provide medical record

documentation that impacts patient care 12 4 33.33% 9

C40: Apparently did not follow up on patient’s

non-compliance 1 0 0.00% 0

C99: Other quality concern not elsewhere

classified 579 84 14.51% 4

Total 3,702 408 11.02% 110

5) DISCHARGE/SERVICE TERMINATION

This table provides information regarding the discharge location of beneficiaries linked to appeals conducted by

Livanta of provider-issued notices of Medicare non-coverage. Data contained in this table represents

discharge/termination of service reviews from August 1, 2015 through April 30, 2016. A shortened timeframe is

necessary to allow for maturity of claims data, which are the source of “Discharge Status” for these cases.

Discharge Status # of Beneficiaries Percent of Beneficiaries

(%)

01: Discharged to home or self care (routine

discharge) 629 21.11%

02: Discharged/transferred to another short-term

general hospital for inpatient care 41 1.38%

03: Discharged/transferred to skilled nursing

facility (SNF) 1,367 45.87%

04: Discharged/transferred to intermediate care

facility (ICF) 32 1.07%

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Discharge Status # of Beneficiaries Percent of Beneficiaries

(%)

05: Discharged/transferred to another type of

institution (including distinct parts) 4 0.13%

06: Discharged/transferred to home under care of

organized home health service organization 617 20.70%

07: Left against medical advice or discontinued

care 10 0.34%

09: Admitted as an inpatient to this hospital 1 0.03%

20: Expired (or did not recover – Christian Science

patient) 36 1.21%

21: Discharged/transferred to court/law

enforcement 3 0.10%

30: Still a patient 6 0.20%

40: Expired at home (Hospice claims only) 0 0.00%

41: Expired in a medical facility (e.g. hospital,

SNF, ICF or free standing Hospice) 0 0.00%

42: Expired – place unknown (Hospice claims

only) 0 0.00%

43: Discharged/transferred to a Federal hospital 2 0.07%

50: Hospice - home 42 1.41%

51: Hospice - medical facility 23 0.77%

61: Discharged/transferred within this institution to

a hospital-based Medicare approved swing bed 2 0.07%

62: Discharged/transferred to an inpatient

rehabilitation facility including distinct part units

of a hospital

118 3.96%

63: Discharged/transferred to a long term care

hospital 32 1.07%

64: Discharged/transferred to a nursing facility

certified under Medicaid but not under Medicare 3 0.10%

65: Discharged/transferred to a psychiatric hospital

or psychiatric distinct part unit of a hospital 9 0.30%

66: Discharged/transferred to a Critical Access

Hospital 0 0.00%

70: Discharged/transferred

to another type of health care institution not

defined elsewhere in code list

3 0.10%

Other 0 0.00%

Total 2,980 100.00%

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6) BENEFICIARY APPEALS OF PROVIDER DISCHARGE/SERVICE TERMINATIONS AND DENIALS OF

HOSPITAL ADMISSIONS OUTCOMES BY NOTIFICATION TYPE

This table provides the number of appeal reviews and the percentage of reviews, specifically for each outcome,

in which Livanta’s independent physician reviewer agreed or disagreed with the discharge.

Appeal Review by Notification Type # of Reviews

Physician Reviewer

Disagreed with

Discharge (%)

Physician Reviewer

Agreed with

Discharge (%)

105: Notice of Non-coverage FFS

Preadmission Notice Concurrent Immediate

Review

260 33.46% 66.54%

106: Notice of Non-coverage FFS

Preadmission Notice Non-immediate Review 6 16.67% 83.33%

107: Notice of Non-coverage FFS Admission

Notice Concurrent Immediate Review 893 32.70% 67.30%

108: Notice of Non-coverage FFS Admission

Notice Non-immediate Review 6 33.33% 66.67%

111: Notice of Non-coverage Request for

QIO Concurrence 56 25.00% 75.00%

117: MA Appeal Review (CORF, HHA,

SNF) 19,901 27.50% 72.48%

118: FFS Expedited Appeal (CORF, HHA,

Hospice, SNF) 12,063 17.68% 82.30%

121: Notice of Non-coverage Continued Stay

Notice Immediate Review - Attending

Physician Concurs

4,126 6.69% 93.24%


Notice Concurrent Non-immediate Review 380 12.89% 87.11%


Retrospective 765 16.60% 83.40%

124: MA Notice of Non-coverage Continued

Stay Notice Immediate Review - Attending

Physician Concurs

1,892 8.62% 91.33%

Total 40,348 21.35% 78.62%

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7) EVIDENCE USED IN DECISION-MAKING

The following table describes one or more of the most common types of evidence or standards of care used to

support Livanta’s review coordinators and independent physician reviewer decisions for medical

necessity/utilization review and appeals. Livanta uses evidence-based guidelines and medical literature to

identify standards of care, where such standards exist.

For quality of care reviews, we have provided one to three of the most highly utilized types of

evidence/standards of care to support Livanta’s review coordinator and independent physician reviewer

decisions for the specific list of diagnostic categories provided in this table. A brief statement of the rationale

for selecting the specific evidence or standards of care is also included.

Review Type Diagnostic

Categories

Evidence/ Standards of

Care Used

Rationale for

Evidence/Standard of Care

Selected

Quality of Care

Pneumonia

UpToDate: Treatment of

hospital-acquired,

ventilator-associated, and

healthcare-associated

pneumonia in adults

UpToDate is a web-based

resource that provides multiple

evidence-based standards of

care and clinical decision

support.

Heart Failure UpToDate: Evaluation of

the patient with suspected

heart failure





support.

Pressure Ulcers UpToDate: Clinical

staging and management

of pressure ulcers





support.

Acute Myocardial

Infarction

UpToDate: Overview of

the acute management of

ST elevation myocardial

infarction





support.

Urinary Tract

Infection

UpToDate: Acute

complicated cystitis and

pyelonephritis





support.

Sepsis UpToDate: Sepsis and the

systemic inflammatory

response syndrome:

Definitions,

epidemiology, and

prognosis





support.

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Review Type Diagnostic

Categories

Evidence/ Standards of

Care Used

Rationale for

Evidence/Standard of Care

Selected

Quality of Care Adverse Drug Events UpToDate: Drug

prescribing for older

adults





support.

Falls UpToDate: Falls:

Prevention in nursing care

facilities and the hospital

setting





support.

Patient Trauma UpToDate: Initial

Management of Trauma in

Adults




care and clinical decision.

Surgical

Complications

UpToDate: Surgical

Complications/Procedure

specific





support.

Review Type Evidence/ Standards

of Care Used Rationale for Evidence/Standard of Care Selected

Medical

Necessity/Utilization

Review

MCG® and Interqual MCG® and InterQual are standard, evidence-based criteria

used to assess when and how individual patients progress

through the continuum of care.

Livanta also applies CMS's Two Midnight Rule, which

states that inpatient admissions are generally appropriate if

the admitting practitioner expected the patient to require a

hospital stay that crossed two midnights and the medical

record supports that reasonable expectation.

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Appeals Medicare Benefit

Policy Manual

According to the Medicare Benefit Policy Manual, Chapter

8, care in a skilled nursing facility (SNF) is covered if four

factors are met.

Physician reviewers apply those four requirements to each

case reviewed. If ANY ONE of those four factors is not met,

a stay in a SNF, even though it might include delivery of

some skilled services, is not covered.

Medicare Managed

Care Guidelines,

Chapter 13

Reconsideration Timing:

“If the QIO upholds a Medicare health plan’s decision to

terminate services in whole or in part, the enrollee may

request, no later than 60 days after notification that the QIO

has upheld the decision, that the QIO reconsider its original

decision.”

CMS Beneficiary

Notices Initiative

(BNI) website

Forms, model letter template language and instructions for

providers.

“The provider must ensure that the beneficiary or

representative signs and dates the NOMNC to demonstrate

that the beneficiary or representative received the notice and

understands that the termination decision can be disputed.”

CMS Publication

100-04, Medicare

Claims Processing

Manual, Chapter 30:

Financial Liability

Protections

Instructions regarding hospital interactions with QIOs:

“Before Medicare can pay for post-hospital extended care

services, it must determine whether the beneficiary had a

prior qualifying hospital stay of at least three consecutive

calendar days.”

The Medicare Quality

Improvement

Organization Manual,

Publication 100-10,

Chapter 7- Denials,

Reconsiderations, &

Appeals.

This includes related instructions for the Quality

Improvement Organization (QIO) processing of Appeals

Local Coverage

Determinations

(LCDs)

These are coverage determinations for specific situations,

and they are published by Medicare Administrative

Contractors for cases within their own jurisdiction.

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Appeals Code of Federal

Regulations

§422.622 Requesting immediate QIO review of the decision

to discharge from the inpatient hospital: “Procedures the

QIO must follow: (1) When the QIO receives the request for

an expedited determination under paragraph (b)(1) of this

section, it must immediately notify the hospital that a request

for an expedited determination has been made. (2) The QIO

determines whether the hospital delivered valid notice

consistent with §405.1205(b)(3). (3) The QIO examines the

medical and other records that pertain to the services in

dispute. (4) The QIO must solicit the views of the

beneficiary (or the beneficiary's representative) who

requested the expedited determination. (5) The QIO must

provide an opportunity for the hospital to explain why the

discharge is appropriate.”

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8) REVIEWS BY GEOGRAPHIC AREA

These tables provide information for Area 1 about the count and percentage by rural vs. urban geographical

locations for Health Service Providers (HSPs) associated with a completed BFCC-QIO review. Table 8A

provides data for Appeals, and Table 8B provides data for Quality of Care reviews.

Table 8A: Appeals Reviews by Geographic Area – Urban and Rural:

Geographic Area # of Providers Percent of Providers in

Service Area (%)

Appeal Reviews

Urban 2,912 88.92%

Rural 357 10.90%

Unknown 6 0.18%

Total 3,275 100.00%

Table 8B: Quality of Care Reviews by Geographic Area – Urban and Rural:

Geographic Area # of Providers Percent of Providers in

Service Area (%)

Quality of Care Reviews

Urban 635 92.84%

Rural 45 6.58%

Unknown 4 0.58%

Total 684 100.00%

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9) OUTREACH AND COLLABORATION WITH BENEFICIARIES

Overview

The outreach and communication efforts of Livanta are designed to generate and maintain a regular flow of

information to major stakeholders and to educate customers in the roles and purposes of the BFCC-QIO.

Ensuring relevant parties have access and exposure to this information is vital to quality control, efficient use of

resources, and a positive customer experience, as it increases situational understanding to all parties involved.

The availability of information and education initiatives allows Livanta to clearly establish expectations with

customers and providers and to educate stakeholders on the roles and purposes of each player. Employing

regularly used platforms of communication, Livanta provides pertinent information to stakeholders in an

efficient and effective manner. This document outlines Livanta’s efforts to provide user-friendly access of

information and educational efforts to all major stakeholders in the BFCC-QIO process.

Beneficiaries and Families

To ensure that beneficiaries and their family members have access to the services of the BFCC-QIO, Livanta

provides a toll-free HelpLine at 1-866-815-5440. The HelpLine also maintains a TTY line at 1-866-868-2289

for use by the hearing impaired. In order to remove any potential language or cultural barriers to using the

services of the BFCC-QIO, Livanta retains a translation firm to translate voice conversations in real-time as

well as to translate any written correspondence into the language of choice for the beneficiary. Additionally,

Livanta’s Intake Center is fully bilingual, offering immediate Spanish language support for callers.

In order to better engage more technology oriented beneficiaries, family members of beneficiaries and their

advocates, Livanta continues to develop and promote the use of the Medicare Quality HelpLine smartphone

app. Users may download the app and automatically connect with a nurse who can help begin the process of

filing a quality of care complaint or an appeal. In addition, Livanta continues to develop and promote the Arrow

program on the Livanta BFCC-QIO website. Arrow allows a user to access up to the minute status information

on individual cases while protecting sensitive information.

Successful Engagement

Due to direct feedback from Livanta’s October 2015 outreach site visit to San Juan, Puerto Rico, it was

determined that the establishment of a local area code phone number for Puerto Rico beneficiaries would

provide an efficient and cost effective method to engage beneficiaries who might otherwise have not placed a

call due to the perception of a language barrier. This feedback was the result of an in-depth sensing session with

members of the Puerto Rico senior advocacy community, as well as further meetings with religious leaders and

state and federal government offices, all conducted on-site in Puerto Rico. This local phone number was warmly

received by the stakeholder community in Puerto Rico and has seen consistent growth in usage since its

implementation in December 2015, seeing a total of 483 calls to date. Livanta continues to engage the

beneficiary and stakeholder community in Puerto Rico to educate on the role of the BFCC-QIO Program and to

accommodate local concerns through the partnerships forged during the outreach trip.

Providers

Livanta continues to regularly engage the provider community through webinars, presentations, and

publications to support ongoing provider education. The information presented can be used by all of Livanta’s

provider community to better understand the role of the BFCC-QIO program in the delivery of quality

healthcare. Livanta’s BFCC-QIO content is routinely updated to keep providers informed about program

requirements, CMS updates, news of interest, and frequently asked questions. Allowing both provider and

beneficiary to access to the Arrow program helps facilitate synchronicity of information amongst stakeholders.

In addition to the regular provider communications and web-based electronic platforms, it continues to engage

BFCC-QIO 11th


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15 | P a g e

provider associations to more efficiently disseminate information in a timely and targeted fashion. This

proactive engagement of the provider community promotes a better understanding of the BFCC-QIO program

and the rapid dissemination of critical programmatic information.

Advocates

Through consistent and targeted outreach, Livanta has engaged directly with advocate groups in every state and

territory in Area 1. Livanta maintains regular contact with area agencies on aging, the State Health Insurance

Assistance Program (SHIP), the Serving the Health Insurance Needs of Everyone (SHINE) offices at the state

and regional level, the state ombudsman programs, Congressional constituent services offices, and ethnic and

cultural advocacy groups. In the past year, Livanta has had on-site collaboration meetings with 47 critical

advocate stakeholders. In order to conduct these meetings, Livanta has invested considerable research time in

order to identify the most effective partner-advocates. Meetings were held on-site in the various states in

territories, including Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, Pennsylvania and Puerto

Rico. Livanta also proactively engages the health staff of members of the House of Representatives and the

United States Senate. These meetings provide valuable insight into regionally specific issues facing beneficiary

populations in the home districts. In the past year, Livanta has conducted one on one briefings with 35

Congressional offices in Area 1. With the successful completion of those visits, Livanta has now met with staff

from all of the Area 1 members of Congress. As with advocates in religious, cultural, ethnic and senior groups,

efforts are ongoing to stay in close communication in order to facilitate engagement and education as Livanta

makes innovations to meet the changing needs of Medicare beneficiaries.

Education through Communication

Because of the rapidly changing nature of healthcare, Livanta is committed to providing up-to-date BFCC-QIO

information to the general public, stakeholders, providers and advocates. To educate customers on these

updates, the CMS Twitter feed @BeneProtection is featured live on Livanta’s website. The Livanta BFCC-QIO

website is available for beneficiaries to access in 10 different languages. Each of the languages represented on

the website reflect either a high volume of speakers in Area 1 or a vulnerable population in Area 1. Thanks to

direct feedback obtained during an outreach trip to meet with beneficiary advocates in New Bedford,

Massachusetts, it was determined that Portuguese language support. As such, Portuguese language support was

added to Livanta’s BFCC-QIO webpages. Thanks to the consistent education and outreach, utilization of

Livanta’s BFCC-QIO webpages has resulted in 122,358 unique users. Each user represents an individual

beneficiary, family member or advocate accessing the resources and information on the website.

Other Partners

Livanta maintains a close working relationship with CMS and regularly collaborates with the Contracting

Officer Representatives (CORS) assigned to the Livanta contract. Livanta also works in conjunction with other

Medicare contractors who support the BFCC-QIO, and will often combine resources to sponsor outreach

initiatives for increased efficiency and effectiveness. In addition to joining the Virgin Islands Healthcare

Coalition Workgroup with the Health Services Advisory Group (the QIN-QIO for the US Virgin Islands),

Livanta has collaborated with the Quality Improvement Professional Research Organization and the Quality

Innovation Network Quality Improvement Organization (QIN-QIO) for Puerto Rico to engage the provider

community there.

BFCC-QIO 11th


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16 | P a g e

10) IMMEDIATE ADVOCACY REVIEWS

Immediate Advocacy is an informal, voluntary process used by Livanta to resolve complaints quickly. This

process begins when the beneficiary or his or her representative contacts Livanta and gives verbal consent to

proceed with the complaint. Once consent is given, Livanta contacts the provider and/or practitioner on behalf

of the Medicare patient. Immediate Advocacy is not appropriate when a patient wants to remain anonymous.

Immediate Advocacy does not take the place of a clinical quality of care review, which includes an assessment

of the patient’s medical records.

# of Beneficiary

Complaints

# of Immediate Advocacy

Reviews

(%) of Total Beneficiary

Complaints Resolved by

Immediate Advocacy

Immediate Advocacy Reviews

1,644

622

37.83%

BFCC-QIO 11th


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17 | P a g e

11) EXAMPLE/SUCCESS STORY

Quality Success Stories

Example 1:

Livanta received a phone call from a Medicare beneficiary who reported that he was unable to obtain his

diabetic test strips and meter due to his physician’s office not submitting the necessary Medicare forms to the

pharmacy. He further reported that the pharmacy faxed the forms to the physician’s office 3 times to complete

and he also hand delivered the forms to the office.

Following the call, Livanta’s Review Coordinator (RC) contacted the provider and spoke to a staff member in

the Risk Management department. The RC requested that the provider complete the necessary paperwork and

fax the information to the pharmacy. Later that day, the RC followed-up with the provider to ensure the task

was completed. The RC discovered that the paperwork submitted to the pharmacy was still incomplete and

covered only the diabetic meter and not the test strips. The RC requested that the provider submit the missing

information and the task was completed.

The RC notified the beneficiary that all of the paperwork was completed and submitted to the pharmacy, and

the beneficiary went to the pharmacy to pick up his diabetic supplies. The beneficiary later called the RC to

confirm that he had all of his diabetic supplies and to thank her for her assistance.

Example 2:

Livanta received a phone call from a Medicare beneficiary who reported that she was recently discharged from

an acute hospital without home health care. Livanta’s RC contacted the hospital’s Home Health Coordinator to

discuss the beneficiary’s discharge plans. Though it was revealed that home health services were ordered by the

physician at discharge, there was difficulty in the initial set-up due to the beneficiary’s residential location and

the inability to finalize by the time the beneficiary left the hospital.

As a result of Livanta’s Immediate Advocacy assistance, the hospital’s Coordinator called the beneficiary and

the home health agency to complete the discharge instructions. Livanta’s RC called the beneficiary to confirm

that services were set, and the beneficiary reported that her home health visit was scheduled for that day.

12) BENEFICIARY HELPLINE STATISTICS

This table provides Livanta’s Area 1 beneficiary HelpLine statistics for the period from August 1, 2015 through

July 31, 2016.

Beneficiary Helpline Report Total Per Category

Total Number of Calls Received 135,780

Total Number of Calls Answered 109,911

Total Number of Abandoned Calls 3,338

Average Length of Call Wait Times 0:13 Seconds

Number of Calls Transferred by 1-800-

Medicare 1,476

BFCC-QIO 11th


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18 | P a g e

CONCLUSION: Livanta’s quality improvement efforts result in the protection of beneficiaries by ensuring that the quality of

health care they receive meets professionally recognized standards of care. During the course of the second year

of their contract, Livanta received 135,780 calls from beneficiaries, collaborated with 3,396 providers and met

personally with 82 critical stakeholders. All of these interactions are important to the Medicare program. The

QIOs support CMS’s initiative of ensuring that all Medicare beneficiaries receive good quality care every time

by ensuring that the medical care is paid for by Medicare when it is medically necessary and the care that is

provided meets the standards of care set by the medical community. The QIOs support Medicare beneficiaries

and providers through the care continuum. During these interactions, Livanta was able to provide information,

education, and determinations that support the Medicare program. The significance of these interactions cannot

be understated.

Through a review of beneficiary complaints and appeals, Livanta ensures that the perspective and unique needs

of beneficiaries and their representatives are heard, understood and considered, both in making decisions about

current care, and in helping health care facilities provide better care for all beneficiaries in the future. Through

the Immediate Advocacy segment of Livanta’s role as BFCC-QIO, rapid resolution to problems with concurrent

care is possible. For example, Immediate Advocacy can resolve logistical issues with care, such as access to

expected supplies or equipment. Within Livanta’s Quality of Care Program, when a quality of care concern is

confirmed, educational feedback is delivered to the provider regarding how care can be improved in future

cases. Likewise, where a systemic issue is identified, cases are referred to the state's local QIN-QIO to provide

local technical assistance to the health care provider organization to address the underlying issues that may have

led to the failure in care.

Through the handling of appeals, EMTALA cases, and utilization reviews, Livanta also protects beneficiary

rights and the integrity of the Medicare Trust Fund by ensuring that Medicare pays for only health care services

and items that are reasonable and medically necessary, and that these services are provided in the most

appropriate setting. This also impacts the quality of care delivered. Any time a health care provider delivers care

that is invasive but not medically necessary, there will be the risk of unnecessary harm to the patient.

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – C o n n e c t i c u t 19 | P a g e

APPENDIX

LIVANTA QIO AREA #1 – STATE OF CONNECTICUT


Review Type # of Reviews

Percent of

TOTAL

Reviews (%)

Coding Validation (120 - HWDRG) 322 8.24%

Coding Validation (All Other Selection Reasons) 0 0.00%

Quality of Care Review (101 through 104 -Beneficiary Complaint) 70 1.79%



Utilization (All Other Selection Reasons) 877 22.43%

Notice of Non-coverage (105 through 108 - Admission and Preadmission) 28 0.72%



Notice of Non-coverage (121 through 124 -Weichardt) 338 8.64%


EMTALA 5 Day 0 0.00%


Total 3,910 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016


2) TOP 10 PRINCIPAL MEDICAL DIAGNOSES

Top 10 Medical Diagnoses # of Beneficiaries Percent of Beneficiaries

(%)

1. 0389 - SEPTICEMIA NOS 6,932 20.97%


ORGANISM 6,272 18.97%

3. 486 - PNEUMONIA, ORGANISM NOS 3,148 9.52%

4. 5849 - ACUTE KIDNEY FAILURE NOS 2,878 8.71%

5. 5990 - URIN TRACT INFECTION NOS 2,663 8.06%

6. N179 - ACUTE KIDNEY FAILURE,

UNSPECIFIED 2,541 7.69%

7. J189 - PNEUMONIA, UNSPECIFIED

ORGANISM 2,393 7.24%

8. 42833 - AC ON CHR DIAST HRT FAIL 2,160 6.53%

9. 42731 - ATRIAL FIBRILLATION 2,061 6.23%

10. I5033 - ACUTE ON CHRONIC

DIASTOLIC (CONGESTIVE) HEART

FAILURE

2,010 6.08%

Total 33,058 100.00%

3) BENEFICIARY DEMOGRAPHICS

Demographics # of Beneficiaries Percent of Beneficiaries

(%)

Sex/Gender

Female 1,685 59.16%

Male 1,146 40.24%

Unknown 17 0.60%

Total 2,848 100.00%

Race

Asian 9 0.32%

Black 202 7.09%

Hispanic 29 1.02%

North American Native 2 0.07%

Other 28 0.98%

Unknown 42 1.47%

White 2,536 89.04%

Total 2,848 100.00%

Age

Under 65 325 11.41%

65-70 334 11.73%

71-80 735 25.81%

81-90 1,042 36.59%

91+ 412 14.47%

Total 2,848 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016


4) PROVIDER REVIEWS SETTINGS

Setting # of Providers Percent of

Providers (%)




3: Distinct Skilled Nursing Facility 194 71.32%

5: Clinic 0 0.00%









O: Setting Does Not Fit Into Any Other Existing Setting Code 0 0.00%


R: Hospice 12 4.41%



U: Swing Bed Hospital Designation for Short-Term, Long-Term Care,

and Rehabilitation Hospitals 0 0.00%



Other 0 0.00%

Total 272 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)

C01: Apparently did not obtain pertinent

history and/or findings from examination 0 0 0.00% 2



C03: Apparently did not establish and/or

develop an appropriate treatment plan for a

defined problem or diagnosis which

prompted this episode of care [excludes

laboratory and/or imaging (see C06 or C09)

and procedures (see C07 or C08) and

consultations (see C13 and C14)

57 7 12.28% 1

C04: Apparently did not carry out an

established plan in a competent and/or

timely fashion

21 3 14.29%

3

C05: Apparently did not appropriately

assess and/or act on changes in

clinical/other status results

6 0 0.00% 0


assess and/or act on laboratory tests or

imaging study results

1 0 0.00% 0




3 0 0.00% 0

C08: Apparently did not perform a

procedure that was indicated (other than lab

and imaging, see C09)

3 0 0.00% 0



C10: Apparently did not develop and

initiate appropriate discharge, follow-up,

and/or rehabilitation plans

12 1 8.33% 1

C11: Apparently did not demonstrate that

the patient was ready for discharge 27 1 3.70% 0

C12: Apparently did not provide

appropriate personnel and/or resources 0 0 0.00% 0



BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)

C14: Apparently specialty consultation

process was not completed in a timely

manner

1 0 0.00% 0

C15: Apparently did not effectively

coordinate across disciplines 4 2 50.00% 0


environment (medication errors, falls,

pressure ulcers, transfusion reactions,

nosocomial infection)

25 3 12.00% 1

C17: Apparently did not order/follow

evidence-based practices 5 2 40.00% 0

C18: Apparently did not provide medical

record documentation that impacts patient

care

1 0 0.00% 1

C40: Apparently did not follow up on

patient’s non-compliance 0 0 0.00% 0


classified 41 8 19.51% 1

Total 242 28 11.57% 10

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Appeal Review by Notification Type # of Reviews (%) of Total

105: Notice of Non-coverage FFS Preadmission Notice Concurrent

Immediate Review 5 0.21%

106: Notice of Non-coverage FFS Preadmission Notice Non-immediate

Review 2 0.08%

107: Notice of Non-coverage FFS Admission Notice Concurrent


108: Notice of Non-coverage FFS Admission Notice Non-immediate

Review 2 0.08%

111: Notice of Non-coverage Request for QIO Concurrence 0 0.00%

117: MA Appeal Review (CORF, HHA, SNF) 1,001 42.20%

118: FFS Expedited Appeal (CORF, HHA, Hospice, SNF) 1,019 42.96%

121: Notice of Non-coverage Continued Stay Notice Immediate Review -

Attending Physician Concurs 206 8.68%

122: Notice of Non-coverage Continued Stay Notice Concurrent Non-

immediate Review 12 0.51%

123: Notice of Non-coverage Continued Stay Retrospective 44 1.85%

124: MA Notice of Non-coverage Continued Stay Notice Immediate

Review - Attending Physician Concurs 62 2.61%

Total 2,372 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016


7) REVIEWS BY GEOGRAPHIC AREA – URBAN AND RURAL


Geographic Area # of Providers

Percent of

Providers in State

(%)

Percent of Providers in

Service Area (%)

Appeal Reviews

Urban 256 95.88% 88.92%

Rural 9 3.37% 10.90%

Unknown 2 0.75% 0.18%

Total 267 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 39 95.12% 92.84%

Rural 1 2.44% 6.58%

Unknown 1 2.44% 0.58%

Total 41 100.00% 100.00%


# of Beneficiary

Complaints # of Immediate Advocacy Reviews



Immediate Advocacy


88

21

23.86%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a s s a c h u s e t t s 26 | P a g e

LIVANTA QIO AREA #1 – STATE OF MASSACHUSETTS



Percent of

TOTAL

Reviews (%)









Notice of Non-coverage (117 - Grijalva) 853 17.12%





Total 4,983 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

1. 0389 - SEPTICEMIA NOS 12,013 18.33%


ORGANISM 11,352 17.32%



ORGANISM 5,915 9.03%



7. J441 - CHRONIC OBSTRUCTIVE

PULMONARY DISEASE W (ACUTE)

EXACERBATION

4,883 7.45%

8. 71536 - LOC OSTEOARTH NOS-L/LEG 4,750 7.25%

9. 42833 - AC ON CHR DIAST HRT FAIL 4,550 6.94%



Total 65,527 100.00%



(%)

Sex/Gender

Female 2,295 60.55%

Male 1,468 38.73%

Unknown 27 0.71%

Total 3,790 100.00%

Race

Asian 33 0.87%

Black 144 3.80%

Hispanic 38 1.00%


Other 40 1.06%

Unknown 50 1.32%

White 3,483 91.90%

Total 3,790 100.00%

Age

Under 65 563 14.85%

65-70 445 11.74%

71-80 898 23.69%

81-90 1,328 35.04%

91+ 556 14.67%

Total 3,790 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 34 7.00%







Other 0 0.00%

Total 486 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












141 11 7.80% 0



timely fashion

26 3 11.54% 2




13 0 0.00% 5




4 0 0.00% 0




5 0 0.00% 0




2 0 0.00% 0






21 0 0.00% 0







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

0 0 0.00% 0







42 6 14.29% 4





care

0 0 0.00% 2





Total 412 42 10.19% 15

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 0 0.00%




Review 1 0.04%


117: MA Appeal Review (CORF, HHA, SNF) 689 27.63%









Total 2,494 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 461 98.50% 88.92%

Rural 7 1.50% 10.90%

Unknown 0 0.00% 0.18%

Total 468 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 81 100.00% 92.84%

Rural 0 0.00% 6.58%

Unknown 0 0.00% 0.58%

Total 81 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


168

51

30.36%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 33 | P a g e

LIVANTA QIO AREA #1 – STATE OF MAINE



Reviews (%)








Preadmission) 51 4.27%

Notice of Non-coverage (118 - BIPA) 144 12.07%






Total 1,193 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 34 | P a g e



(%)


ORGANISM 1,977 20.14%


ORGANISM 1,432 14.59%

3. I214 - NON-ST ELEVATION (NSTEMI)

MYOCARDIAL INFARCTION 1,212 12.35%



EXACERBATION

1,030 10.49%

5. 0389 - SEPTICEMIA NOS 784 7.99%



FAILURE

775 7.90%

7. N390 - URINARY TRACT INFECTION,

SITE NOT SPECIFIED 674 6.87%

8. V5789 - REHABILITATION PROC NEC 668 6.81%


UNSPECIFIED 637 6.49%

10. 486 - PNEUMONIA, ORGANISM NOS 627 6.39%

Total 9,816 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 35 | P a g e



(%)

Sex/Gender

Female 436 55.68%

Male 337 43.04%

Unknown 10 1.28%

Total 783 100.00%

Race

Asian 1 0.13%

Black 4 0.51%

Hispanic 1 0.13%


Other 2 0.26%

Unknown 13 1.66%

White 758 96.81%

Total 783 100.00%

Age

Under 65 139 17.75%

65-70 95 12.13%

71-80 206 26.31%

81-90 255 32.57%

91+ 88 11.24%

Total 783 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 36 | P a g e



Providers (%)





5: Clinic 0 0.00%











R: Hospice 4 3.85%







Other 0 0.00%

Total 104 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 37 | P a g e



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












19 1 5.26% 0



timely fashion

4 0 0.00% 0




4 1 25.00% 0




1 0 0.00% 0




1 0 0.00% 0




0 0 0.00% 0






5 0 0.00% 0







BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 38 | P a g e


Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

0 0 0.00% 1







6 1 16.67% 1





care

0 0 0.00% 0





Total 57 7 12.28% 3

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 39 | P a g e







Review 0 0.00%




Review 0 0.00%



118: FFS Expedited Appeal (CORF, HHA, Hospice, SNF) 134 24.19%








Total 554 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – M a i n e 40 | P a g e




Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 53 53.54% 88.92%

Rural 45 45.45% 10.90%

Unknown 1 1.01% 0.18%

Total 99 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 11 64.71% 92.84%

Rural 5 29.41% 6.58%

Unknown 1 5.88% 0.58%

Total 17 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


23

5

21.74%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – N e w H a m p s h i r e 41 | P a g e

LIVANTA QIO AREA #1 – STATE OF NEW HAMPSHIRE



Percent of

TOTAL

Reviews (%)














Total 1,112 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)


ORGANISM 2,083 15.59%

2. 0389 - SEPTICEMIA NOS 1,949 14.59%



ORGANISM 1,360 10.18%

5. V5789 - REHABILITATION PROC NEC 1,336 10.00%



EXACERBATION

1,158 8.67%

7. 71536 - LOC OSTEOARTH NOS-L/LEG 1,137 8.51%

8. 41071 - SUBENDO INFARCT, INITIAL 1,033 7.73%

9. 49121 - OBS CHR BRONC W(AC) EXAC 992 7.42%


MYOCARDIAL INFARCTION 955 7.15%

Total 13,363 100.00%



(%)

Sex/Gender

Female 425 58.06%

Male 305 41.67%

Unknown 2 0.27%

Total 732 100.00%

Race

Asian 5 0.68%

Black 4 0.55%

Hispanic 1 0.14%


Other 6 0.82%

Unknown 11 1.50%

White 703 96.04%

Total 732 100.00%

Age

Under 65 123 16.80%

65-70 108 14.75%

71-80 210 28.69%

81-90 203 27.73%

91+ 88 12.02%

Total 732 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 4 5.00%







Other 0 0.00%

Total 80 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












15 2 13.33% 0



timely fashion

4 0 0.00% 0




0 0 0.00% 1




0 0 0.00% 0




1 0 0.00% 0




0 0 0.00% 0






1 0 0.00% 1







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

1 0 0.00% 0







6 1 16.67% 0





care

0 0 0.00% 0





Total 47 5 10.64% 2

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 0 0.00%




Review 1 0.29%











Total 345 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 52 69.33% 88.92%

Rural 23 30.67% 10.90%

Unknown 0 0.00% 0.18%

Total 75 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 14 87.50% 92.84%

Rural 2 12.50% 6.58%

Unknown 0 0.00% 0.58%

Total 16 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


22

7

31.82%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – N e w J e r s e y 48 | P a g e

LIVANTA QIO AREA #1 – STATE OF NEW JERSEY



Percent of

TOTAL

Reviews (%)

Coding Validation (120 - HWDRG) 1,951 14.11%









Notice of Non-coverage (121 through 124 -Weichardt) 1,625 11.75%




Total 13,826 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)


ORGANISM 14,073 22.74%

2. 0389 - SEPTICEMIA NOS 7,922 12.80%


ORGANISM 6,630 10.71%



EXACERBATION

5,828 9.42%




SITE NOT SPECIFIED 5,279 8.53%





FAILURE

4,129 6.67%



Total 61,900 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

Sex/Gender

Female 5,176 58.70%

Male 3,617 41.02%

Unknown 25 0.28%

Total 8,818 100.00%

Race

Asian 143 1.62%

Black 1,262 14.31%

Hispanic 216 2.45%


Other 135 1.53%

Unknown 70 0.79%

White 6,988 79.25%

Total 8,818 100.00%

Age

Under 65 1,113 12.62%

65-70 1,103 12.51%

71-80 2,561 29.04%

81-90 2,987 33.87%

91+ 1,054 11.95%

Total 8,818 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 37 8.11%







Other 0 0.00%

Total 456 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












156 11 7.05% 1



timely fashion

43 4 9.30% 3




37 0 0.00% 2




7 2 28.57% 1




13 7 53.85% 0




4 0 0.00% 0






35 8 22.86% 3







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

4 3 75.00% 2







68 4 5.88% 0





care

2 0 0.00% 1




classified 104 11 10.58% 1

Total 606 60 9.90% 21

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 0 0.00%




Review 0 0.00%





Attending Physician Concurs 1,052 15.72%






Total 6,691 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 445 100.00% 88.92%

Rural 0 0.00% 10.90%

Unknown 0 0.00% 0.18%

Total 445 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 114 100.00% 92.84%

Rural 0 0.00% 6.58%

Unknown 0 0.00% 0.58%

Total 114 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


266 103

38.72%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – N e w Y o r k 56 | P a g e

LIVANTA QIO AREA #1 – STATE OF NEW YORK



Percent of

TOTAL

Reviews (%)














Total 25,574 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

1. 0389 - SEPTICEMIA NOS 29,852 22.50%


ORGANISM 26,934 20.30%



ORGANISM 11,245 8.48%





EXACERBATION

8,878 6.69%

8. 49121 - OBS CHR BRONC W(AC) EXAC 8,083 6.09%





Total 132,672 100.00%



(%)

Sex/Gender

Female 9,836 60.30%

Male 6,407 39.28%

Unknown 68 0.42%

Total 16,311 100.00%

Race

Asian 282 1.73%

Black 2,399 14.71%

Hispanic 438 2.69%


Other 315 1.93%

Unknown 211 1.29%

White 12,641 77.50%

Total 16,311 100.00%

Age

Under 65 2,241 13.74%

65-70 2,048 12.56%

71-80 4,284 26.26%

81-90 5,558 34.08%

91+ 2,180 13.37%

Total 16,311 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 27 3.38%







Other 0 0.00%

Total 800 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












271 17 6.27% 4



timely fashion

98 11 11.22% 5




43 6 13.95% 2




13 2 15.38% 0




17 5 29.41% 0




20 7 35.00% 0






59 3 5.08% 1







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

5 0 0.00% 2







104 12 11.54% 1





care

3 1 33.33% 0




classified 185 31 16.76% 10

Total 1,111 125 11.25% 32

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 6 0.05%




Review 4 0.03%





Attending Physician Concurs 1,698 14.07%






Total 12,065 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 691 88.59% 88.92%

Rural 86 11.03% 10.90%

Unknown 3 0.38% 0.18%

Total 780 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 155 92.26% 92.84%

Rural 12 7.14% 6.58%

Unknown 1 0.60% 0.58%

Total 168 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


560

261

46.61%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – P e n n s y l v a n i a 63 | P a g e

LIVANTA QIO AREA #1 – STATE OF PENNSYLVANIA



Reviews (%)








Preadmission) 11 0.05%







Total 23,709 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)


ORGANISM 18,118 22.63%

2. 0389 - SEPTICEMIA NOS 9,084 11.35%


ORGANISM 8,907 11.12%





EXACERBATION

7,454 9.31%



7. V5789 - REHABILITATION PROC NEC 6,360 7.94%





FAILURE

5,537 6.92%


Total 80,066 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

Sex/Gender

Female 10,394 61.10%

Male 6,459 37.97%

Unknown 158 0.93%

Total 17,011 100.00%

Race

Asian 83 0.49%

Black 1,745 10.26%

Hispanic 76 0.45%


Other 85 0.50%

Unknown 213 1.25%

White 14,805 87.03%

Total 17,011 100.00%

Age

Under 65 2,058 12.10%

65-70 2,091 12.29%

71-80 4,519 26.57%

81-90 6,165 36.24%

91+ 2,178 12.80%

Total 17,011 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 73 7.36%







Other 0 0.00%

Total 992 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












236 22 9.32% 3



timely fashion

80 9 11.25% 5




44 5 11.36% 7




6 3 50.00% 0




11 1 9.09% 0




11 2 18.18% 0






50 5 10.00% 0







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

8 0 0.00% 1







88 9 10.23% 1





care

5 2 40.00% 1




classified 138 18 13.04% 1

Total 919 96 10.45% 27

BFCC-QIO 11th


08/01/2015 – 07/31/2016



HOSPITAL ADMISSIONS OUTCOMES BY NOTIFICATION TYPE.





Review 0 0.00%




Review 0 0.00%











Total 16,276 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 802 83.72% 88.92%

Rural 156 16.28% 10.90%

Unknown 0 0.00% 0.18%

Total 958 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 169 88.48% 92.84%

Rural 21 10.99% 6.58%

Unknown 1 0.52% 0.58%

Total 191 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


387

123

31.78%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – P u e r t o R i c o 71 | P a g e

LIVANTA QIO AREA #1 – PUERTO RICO



Percent of

TOTAL

Reviews (%)














Total 526 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)






ORGANISM 453 11.86%


ORGANISM 441 11.54%



EXACERBATION

397 10.39%

6. I509 - HEART FAILURE, UNSPECIFIED 300 7.85%

7. J180 - BRONCHOPNEUMONIA,

UNSPECIFIED ORGANISM 298 7.80%

8. D649 - ANEMIA, UNSPECIFIED 293 7.67%

9. I639 - CEREBRAL INFARCTION,


10. I25110 - ATHSCL HEART DISEASE OF

NATIVE COR ART W UNSTABLE ANG

PCTRS

253 6.62%

Total 3,820 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

Sex/Gender

Female 176 53.17%

Male 151 45.62%

Unknown 4 1.21%

Total 331 100.00%

Race

Asian 0 0.00%

Black 18 5.44%

Hispanic 58 17.52%


Other 13 3.93%

Unknown 6 1.81%

White 236 71.30%

Total 331 100.00%

Age

Under 65 64 19.34%

65-70 55 16.62%

71-80 114 34.44%

81-90 77 23.26%

91+ 21 6.34%

Total 331 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 14 20.59%







Other 0 0.00%

Total 68 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












46 5 10.87% 0



timely fashion

19 4 21.05% 1




9 2 22.22% 1




5 4 80.00% 0




0 0 0.00% 0




0 0 0.00% 0






8 0 0.00% 3







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

1 0 0.00% 0







18 4 22.22% 2





care

0 0 0.00% 0





Total 182 34 18.68% 11

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 0 0.00%




Review 0 0.00%











Total 178 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 47 97.92% 88.92%

Rural 1 2.08% 10.90%

Unknown 0 0.00% 0.18%

Total 48 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 40 97.56% 92.84%

Rural 1 2.44% 6.58%

Unknown 0 0.00% 0.58%

Total 41 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


80

36

48.75%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – R h o d e I s l a n d 79 | P a g e

LIVANTA QIO AREA #1 – STATE OF RHODE ISLAND



Percent of

TOTAL

Reviews (%)














Total 1,565 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

1. 0389 - SEPTICEMIA NOS 1,838 22.08%


ORGANISM 1,418 17.03%



EXACERBATION

710 8.53%

4. 5849 - ACUTE KIDNEY FAILURE NOS 681 8.18%

5. 41071 - SUBENDO INFARCT, INITIAL 631 7.58%

6. 49121 - OBS CHR BRONC W(AC) EXAC 626 7.52%


8. 5990 - URIN TRACT INFECTION NOS 617 7.41%

9. 42833 - AC ON CHR DIAST HRT FAIL 598 7.18%

10. 71536 - LOC OSTEOARTH NOS-L/LEG 588 7.06%

Total 8,325 100.00%



(%)

Sex/Gender

Female 644 60.19%

Male 422 39.44%

Unknown 4 0.37%

Total 1,070 100.00%

Race

Asian 4 0.37%

Black 42 3.93%

Hispanic 13 1.21%


Other 6 0.56%

Unknown 7 0.65%

White 997 93.18%

Total 1,070 100.00%

Age

Under 65 169 15.79%

65-70 112 10.47%

71-80 250 23.36%

81-90 374 34.95%

91+ 165 15.42%

Total 1,070 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 3 3.09%







Other 0 0.00%

Total 97 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












33 2 6.06% 0



timely fashion

9 0 0.00% 0




2 0 0.00% 0




1 0 0.00% 0




1 0 0.00% 0




0 0 0.00% 0






3 1 33.33% 0







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

0 0 0.00% 0







6 0 0.00% 0





care

0 0 0.00% 0





Total 94 7 7.45% 2

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 0 0.00%




Review 0 0.00%











Total 879 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 96 100.00% 88.92%

Rural 0 0.00% 10.90%

Unknown 0 0.00% 0.18%

Total 96 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 10 100.00% 92.84%

Rural 0 0.00% 6.58%

Unknown 0 0.00% 0.58%

Total 10 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


34

7

20.59%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – V i r g i n I s l a n d s 86 | P a g e

LIVANTA QIO AREA #1 – US VIRGIN ISLANDS



Percent of

TOTAL

Reviews (%)














Total 45 0.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

1. I639 - CEREBRAL INFARCTION,



ORGANISM 31 12.25%

3. I509 - HEART FAILURE, UNSPECIFIED 30 11.86%



5. 43491 - CRBL ART OCL NOS W INFRC 26 10.28%

6. I5023 - ACUTE ON CHRONIC SYSTOLIC

(CONGESTIVE) HEART FAILURE 24 9.49%



8. I638 - OTHER CEREBRAL INFARCTION 17 6.72%

9. E860 - DEHYDRATION 16 6.32%

10. I4891 - UNSPECIFIED ATRIAL

FIBRILLATION 15 5.93%

Total 253 100.00%



(%)

Sex/Gender

Female 14 43.75%

Male 18 56.25%

Unknown 0 0.00%

Total 32 100.00%

Race

Asian 0 0.00%

Black 21 65.63%

Hispanic 3 9.38%


Other 1 3.13%

Unknown 0 0.00%

White 7 21.88%

Total 32 100.00%

Age

Under 65 0 0.00%

65-70 8 25.00%

71-80 14 43.75%

81-90 9 28.13%

91+ 1 3.13%

Total 32 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 0 0.00%







Other 0 0.00%

Total 2 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












2 0 0.00% 0



timely fashion

1 0 0.00% 0




3 0 0.00% 0




1 0 0.00% 0




0 0 0.00% 0




0 0 0.00% 0






1 0 0.00% 0







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

0 0 0.00% 0







0 0 0.00% 0





care

0 0 0.00% 0





Total 12 0 0.00% 0

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 0 0.00%




Review 0 0.00%











Total 13 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 0 0.00% 88.92%

Rural 2 100.00% 10.90%

Unknown 0 0.00% 0.18%

Total 2 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 0 0.00% 92.84%

Rural 1 100.00% 6.58%

Unknown 0 0.00% 0.58%

Total 1 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


8

3

37.50%

BFCC-QIO 11th


08/01/2015 – 07/31/2016

A r e a 1 – V e r m o n t 93 | P a g e

LIVANTA QIO AREA #1 – STATE OF VERMONT



Percent of

TOTAL

Reviews (%)














Total 45 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)


ORGANISM 838 21.38%


ORGANISM 548 13.98%





EXACERBATION

420 10.71%

5. 0389 - SEPTICEMIA NOS 333 8.49%








FAILURE

262 6.68%

10. M1711 - UNILATERAL PRIMARY

OSTEOARTHRITIS, RIGHT KNEE 251 6.40%

Total 3,920 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




(%)

Sex/Gender

Female 119 55.09%

Male 94 43.52%

Unknown 3 1.39%

Total 216 100.00%

Race

Asian 0 0.00%

Black 1 0.46%

Hispanic 0 0.00%


Other 1 0.46%

Unknown 5 2.31%

White 209 96.76%

Total 216 100.00%

Age

Under 65 26 12.04%

65-70 34 15.74%

71-80 55 25.46%

81-90 79 36.57%

91+ 22 10.19%

Total 216 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Providers (%)





5: Clinic 0 0.00%











R: Hospice 1 2.56%







Other 0 0.00%

Total 39 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016




Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)












5 1 20.00% 1



timely fashion

1 0 0.00% 0




2 1 50.00% 0




0 0 0.00% 0




0 0 0.00% 0




1 0 0.00% 0






1 0 0.00% 0







BFCC-QIO 11th


08/01/2015 – 07/31/2016



Category Codes

# of

Concerns

# of Concerns

Confirmed

Percent

Confirmed

Concerns

(%)

# of Concerns

Referred as

Quality

Improvement

Initiatives (QII)



manner

0 0 0.00% 0







1 0 0.00% 0





care

1 1 100.00% 0





Total 20 4 20.00% 2

BFCC-QIO 11th


08/01/2015 – 07/31/2016








Review 0 0.00%




Review 0 0.00%











Total 13 100.00%

BFCC-QIO 11th


08/01/2015 – 07/31/2016





Percent of

Providers in State

(%)


Service Area (%)

Appeal Reviews

Urban 9 24.32% 88.92%

Rural 28 15.68% 10.90%

Unknown 0 0.00% 0.18%

Total 37 100.00% 100.00%



Percent of

Providers in State

(%)


Service Area (%)


Urban 2 50.00% 92.84%

Rural 2 50.00% 6.58%

Unknown 0 0.00% 0.58%

Total 4 100.00% 100.00%


# of Beneficiary




Immediate Advocacy


8

2

25.00%

This material was prepared by Livanta LLC, the Medicare Quality Improvement Organization for BFCC Areas 1 and 5, under contract

with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The

contents presented do not necessarily reflect CMS policy. 11SOW-MD-2016-QIOBFCC-CP2

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