Medical Reviews

For more than two decades, CFMC has provided medical case review services for the Centers for Medicare & Medicaid Services (CMS). This program is designed to protect beneficiaries by expeditiously addressing individual cases such as beneficiary quality of care complaints, hospital issued notices of noncoverage (HINNs), dumping (turning away patients at emergency rooms), and advance beneficiary notices (ABNs) issued by physicians.

CFMC'sBeneficiary Quality of Care Hotline number is 1.800.727.7086. Beneficiaries should call this number if they have concerns about the quality of medical services they have received through the Medicare program.

CFMC conducts reviews in the following settings:

Inpatient hospitals/units
Hospital outpatient areas
Ambulatory surgical centers
Comprehensive outpatient rehabilitation facilities
Critical access hospitals
Hospices
Outpatient physical therapy and speech/language pathology services
Skilled nursing facilities
Specialty hospitals (e.g., psychiatric and rehabilitation)
Emergency rooms
Home health agencies

The Colorado Foundation for Medical Care (CFMC), the Medicare quality improvement organization for Colorado, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS Policy.