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Case review for Oregon's Medicare beneficiaries transitions to a new contractor

Beginning Aug. 1, Maryland-based Livanta LLC will perform medical case review on behalf of Oregon’s Medicare beneficiaries — a function currently performed by Portland-based Acumentra Health.

The shift results from rule changes impacting the federal Quality Improvement Organization (QIO) program. The Centers for Medicare and Medicaid Services (CMS) is splitting the QIO program’s core functions of quality improvement (QI) and beneficiary case review. Under the new rules, an organization cannot serve as a contractor for both roles. By designating a special organization to address beneficiary and family concerns, CMS seeks to enhance the quality of services to Medicare beneficiaries.

Acumentra Health currently handles both QI activities and beneficiary case review, and is working with CMS to support the transition of case review to Livanta.

“We are proud to have served Medicare beneficiaries and their families for the past three decades through our medical case review role, and we’re committed to supporting this transition by communicating with affected stakeholders,” said Jon Mitchell, president and CEO of Acumentra Health. “The new CMS rules required us to choose which of our long-time core activities to continue to pursue and which to give up. We’ve proposed to continue to work with hospitals and doctors to promote quality improvement across the spectrum of care, which best aligns with our corporate mission.”

Livanta will be responsible for protecting the rights of Medicare beneficiaries through quality-of-care reviews, beneficiary complaint reviews, and beneficiary appeals of discharge and termination of services, medical necessity reviews, and Emergency Medical Treatment and Active Labor Act (EMTALA) reviews. The new case review contractor intends to continue to use Oregon physicians (and other Oregon licensed individual practitioners) to conduct peer review in Oregon.

The transition of case review services to Livanta will affect hospitals and other providers subject to Medicare requirements, such as medical record review for Medicare coverage and discharge appeals, and for quality-of-care concerns raised by beneficiaries. Providers will need to update QIO contact information on forms provided to beneficiaries and on policy documents to inform their staff.

Oregon Medicare beneficiaries and family members who have concerns or questions about the quality of care received, or who wish to appeal termination of services or a discharge notice from a hospital or other medical provider, should call Livanta at 1-877-588-1123.

As the transition proceeds, Acumentra Health will share more information at acumentra.org/BFCC. If you have questions, contact Medicare review manager Denise Phillips, RN, CHC, at This email address is being protected from spambots. You need JavaScript enabled to view it. .



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