March 18, 2024

Dear Colleague,

We are emailing you to provide notification that the submission process is now available for the required calendar year 2023 Physician Acknowledgements. Please submit the required documentation by May 3, 2023.


Step 1: Download the Livanta Physician Attestation/ Acknowledgement spreadsheet tool from Livanta's BFCC-QIO website: Physician Attestation/ Acknowledgement Spreadsheet Tool

Step 2: Read and follow the instructions on the first tab of the spreadsheet.

Step 3: Send an email with the completed spreadsheet along with signed attestations/ acknowledgements (PDF format) for all physicians listed in the spreadsheet to

Please note that use of Livanta's Physician Attestation/ Acknowledgement Spreadsheet Tool will expedite processing of your submissions and that the use of proprietary encrypted/ secure emails and non-standard spreadsheets will either delay or prevent processing.
About Physician Acknowledgement Statements: Medicare requires hospitals paid under the Prospective Payment System (PPS) to obtain a signed acknowledgement/attestation statement from each physician who is granted admitting privileges and to annually submit this information to the Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO) as per 42 CFR 412.46. Livanta is the BFCC-QIO for case review services for your state or territory.  

To read more about Physician Acknowledgement reporting
requirements, please visit our website at:

Thank you for your prompt attention to this matter. If you have questions about the Physician Acknowledgement requirements, please send your questions in an email to

Best regards,

Livanta BFCC-QIO Communications