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Case Review Connections
A Newsletter for Healthcare Providers and Stakeholders Acute Care Edition Issue 45: August/September 2025 Do you receive the Case Review Connections newsletter? If not, sign up for Acentra Health's email list to receive important news and updates as well as the bi-monthly newsletter. |
If you want to communicate BFCC-QIO information, please email Acentra Health at QIOCommunications@acentra.com and request a newsletter insert or fact sheet for your organization. Please do not copy and paste information from Case Review Connections.
If you find the information in this newsletter useful, please encourage your co-workers and colleagues to sign up: https://acentraqio.com/newsletters
learn about the basics of the bfcc-qio: october 22, 2025 - 2 pm et
Want to learn more about the basics of the BFCC-QIO?
This webinar will provide a very general overview of the services that the BFCC-QIO offers for Medicare beneficiaries (beneficiary complaints, appeals, and Immediate Advocacy services).
This webinar will be beneficial for new staff or someone new in their role as well as stakeholders that work with people with Medicare.
For more information and to register, visit our registration page.
in this issue:
medical director's corner - jessica whitley, md, mba
CMS Quality Conference 2025 - July 1 - 2, 2025
At the 2025 Centers for Medicare & Medicaid Services (CMS) Quality Conference, Chief Medical Officer Dr. Dora Hughes and Administrator Dr. Oz outlined a forward-looking strategy focused on real-time quality measurement, transparency, and chronic disease management. The agency urged providers to adopt innovative tools and data-driven approaches to improve care outcomes and enhance patient safety.
A major focus was the prevention of patient harm as highlighted by an Office of the Inspector General (OIG) report showing that 25% of Medicare patients are harmed during hospital stays, half preventable. CMS is calling for improved harm detection systems and patient education to address this issue. Transparency also took center stage, with CMS promoting public-facing performance dashboards to empower patients and drive accountability.
Digital tools, such as mobile apps, patient portals, and AI-driven chat assistants, that promote health literacy were discussed. Tailored content, clear navigation of the appeals process, and education on identifying and preventing medical errors are key elements.
Chronic disease management was emphasized as a pathway to reduce avoidable hospitalizations linked to poorly managed chronic conditions. Long-term data can be used to spot systemic gaps in care. Also, hospitals can work with primary care teams to build more proactive and preventive care models.
From a financial oversight perspective, CMS continues to focus on containing spending while improving outcomes. With improper Medicare payments and fraud on the rise, providers were advised to use predictive analytics to flag anomalies, conduct targeted audits, and minimize medical necessity errors.
Ultimately, CMS’ message is clear: providers who embrace technology, transparency, and patient-centered strategies will lead in the evolving, value-based healthcare landscape.
All CMS Quality Conference 2025 sessions are available at www.cmsqualcon.com for registered participants. If you did not previously register, registration is still available.
appeals update - new appeals podcast
Acentra Health has a new podcast! Focusing on the appeals process, this podcast contains helpful information for beneficiaries or their families. If you have beneficiaries with questions about the appeals process, please direct them to our podcast or our YouTube channel. We have resources to help them better understand the process and what to expect.
acentra health resources - youtube channel
Acentra Health has many educational videos related to all our review types, which we have been updating recently. If you have new staff who are unfamiliar with the different types of notices, please check out our channel.
health observance - national immunization awareness month
August is National Immunization Awareness Month! This is an annual observance highlighting the importance of vaccinations for people of all ages. The Centers for Disease Control and Prevention (CDC) has recommendations for how healthcare staff can encourage vaccinations during this time.
rural health
CMS released a report in late 2024 summarizing its efforts related to health care in rural, tribal, and geographically isolated communities. As a reminder, these are the three goals that CMS laid out for these communities:
- Ensure affordable, accessible care for all
- Eliminate avoidable differences in health outcomes
- Provide the care and support people need to thrive
Publication No. R146810-192-08/2025. This material was prepared by Acentra Health, a Medicare Quality Improvement Organization 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.
