How to Fill Out the Quality of Care Complaint Form

Acentra Health is the Beneficiary and Family Centered Care Quality Improvement Organization (also known as a BFCC-QIO) for the 29 states shown on our website, www.acentraqio....
Acentra Health helps people with Medicare file complaints about quality of healthcare services and make requests to appeal a hospital discharge or stopping of skilled services such as physical therapy. We also offer Immediate Advocacy services when issues need to be taken care of right away.
If you are unhappy with the medical care you had from a healthcare provider, such as a hospital or skilled nursing facility and you received care in one of the 29 states served by Acentra Health, you can call us and one of our staff will talk with you about filing a quality of care complaint.
This video goes over how to fill out a quality of care complaint form.
Quality of care complaint form: www.cms.gov/Me... (PDF)
Read about how to file a quality of care complaint form: acentraqio.com...
Any person you choose, such as a family member or friend, may help you file a quality of care concern. You must first fill out this form to appoint a representative: www.cms.gov/Me... (PDF)
If you signed the form digitally, email the completed form to Acentra Health: [e-mail].
If you printed the form out and signed it, please use the mailing address for the state where the patient received medical care. You can find mailing addresses on our contact page: acentraqio.com....
Get details about the process and what to expect when a complaint is filed: acentraqio.com... (PDF)
Visit www.acentraqio.... to learn about Acentra Health’s free services for people who have Medicare.
Publication No. R146810-67-07/2024. 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.