US · guidance
CMS Pub. 100-04, ch. 30, § 200.4.2
Beneficiary Liability During BFCC-QIO Review
When the beneficiary makes a timely request for a BFCC-QIO expedited determination
per §200.4.1.1, the beneficiary is not financially responsible for inpatient hospital
services (except applicable coinsurance and deductibles) furnished before noon of the
calendar day after the date the beneficiary receives notification of the expedited
determination from the BFCC-QIO. Please see §200.5.6 for QIO notification
requirements.
When Liability Begins
BFCC-QIO determination
Liability begins
Unfavorable to the beneficiary
Noon of the day after the BFCC -QIO
notifies the beneficiary of the decision.
Favorable to the beneficiary
Once the hospital again determines that
the beneficiary no longer requires
inpatient care, determines a new last date
of coverage and notifies the beneficiary
with a follow-up copy of the IM.
History
(Rev. 11210; Issued: 01-21-2022; Effective: 04-21-2022; Implementation: 04-21- 2022)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
6239086f76fd9d8843d1dab42dd4bdad35bc8c3bc1fb2dd300b04e2c8f0e0cc7
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