A QIO, or Quality Improvement Organization, is an independent group hired by Medicare to protect patients and help healthcare providers deliver better care. These organizations are authorized under federal law and contracted by the Centers for Medicare & Medicaid Services (CMS) to review medical care, handle patient complaints, and work directly with hospitals, nursing homes, and doctor’s offices on safety and quality improvements. If you’ve encountered the term on a hospital form or Medicare notice, it likely relates to one of two specific functions: reviewing whether your care met acceptable standards, or helping a healthcare facility improve how it operates.
Two Types of QIOs and What They Do
CMS splits the QIO program into two distinct branches, each with a different job.
Beneficiary and Family Centered Care QIOs (BFCC-QIOs) are the patient-facing side. They handle complaints about the quality of care you received, review appeals when you believe you’re being discharged from a hospital too early, and advocate for patients in real time. Two organizations currently hold these national contracts: Commence Health (formerly Livanta) and Acentra. Which one covers you depends on your state. The current BFCC-QIO contract period runs from May 2024 through April 2029.
Quality Innovation Network QIOs (QIN-QIOs) are the provider-facing side. Seven QIN-QIO contractors work directly with nursing homes, hospitals, and physician offices to improve how care is delivered to Medicare patients. Their focus areas include disease prevention, patient safety, chronic disease management, behavioral health, emergency preparedness, care coordination, and workforce challenges. They offer hands-on technical assistance, data analytics support, evidence-based recommendations, and customized training. The newest QIN-QIO contract period began in May 2025 and runs through May 2030.
How QIOs Help Patients With Complaints
If you receive Medicare and believe you got poor-quality care, the BFCC-QIO is the organization that investigates. This covers care in virtually any setting except dialysis facilities. The kinds of concerns they review include situations where abnormal test results didn’t lead to treatment, where you were sent home from the hospital while still in severe pain, where discharge instructions were unclear or missing, where drug errors occurred, or where you received unnecessary or inappropriate surgeries or treatments.
To file a complaint, you contact the BFCC-QIO that covers your state. You can find the correct organization through the Commence Health or Acentra websites. The QIO then reviews your medical records, gathers relevant information, and determines whether the care you received met acceptable quality standards.
Your Right to Appeal a Hospital Discharge
One of the most practically important things a QIO does is review hospital discharge decisions. If you’re a Medicare patient and you believe you’re being sent home too soon, you have the legal right to appeal that decision through the QIO. Hospitals are required to give you a form called the “Important Message from Medicare” that explains this right and provides the QIO’s contact information.
The appeal process works in five steps. First, you contact the QIO no later than your planned discharge date and before you leave the hospital. You can file any day of the week, and your appeal officially begins once you speak to someone or leave a message. Second, the hospital provides a detailed written notice explaining why they believe you’re ready for discharge. Third, the QIO may ask for your perspective, either verbally or in writing. Fourth, the QIO reviews your medical records. Fifth, the QIO notifies you of its decision within one day after receiving all necessary information.
The financial protection here is significant. If you file your appeal before the discharge deadline, you can stay in the hospital while the review happens without paying for that continued stay (other than your normal copays and deductibles). If the QIO agrees you’re not ready for discharge, Medicare keeps covering your hospital care. If the QIO sides with the hospital, Medicare still covers your services until noon the day after you’re notified of the decision, giving you time to arrange next steps.
Missing the deadline doesn’t eliminate your options entirely. You can still request a QIO review after the fact, but different rules apply and you may be responsible for costs incurred after the original discharge date.
How QIOs Work With Healthcare Providers
On the provider side, QIN-QIOs function as consultants and coaches. Rather than punishing hospitals or nursing homes for poor performance, they work alongside staff to identify problems and implement solutions. A nursing home struggling with infection rates, for example, might receive on-site training, access to data showing how their outcomes compare to similar facilities, and step-by-step guidance on evidence-based practices that reduce infections.
The scope of this work is broad. QIN-QIOs address patient safety issues like medication errors and hospital-acquired infections, help facilities reduce unnecessary hospital readmissions, support better management of chronic conditions like diabetes and heart failure, and build capacity in behavioral health care. They also help providers prepare for emergencies and address staffing challenges that can compromise care quality. All of this is funded through the Medicare program, so providers receive these services at no cost.
How the QIO Program Is Structured
CMS organizes QIO work in multi-year contract cycles called “Scopes of Work.” The program is currently operating under its 12th and 13th iterations. CMS awarded the 12th Scope of Work contract to 12 QIN-QIO contractors in November 2019, and the newer contracts have consolidated that number to seven QIN-QIOs covering all U.S. states and territories. On the beneficiary side, two BFCC-QIO contractors split the country between them, handling case reviews and claims reviews nationwide.
The QIO program has existed for decades as one of Medicare’s core mechanisms for ensuring that the care it pays for actually meets quality standards. Unlike accreditation bodies that certify facilities or insurance companies that process claims, QIOs occupy a unique middle ground: they’re external to both the government and the healthcare facilities they work with, giving them independence to evaluate care objectively while still being close enough to providers to drive real changes in how medicine is practiced day to day.