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February 14, 2018

Select States and Territories to Be First to Receive New Medicare Cards

The Centers for Medicare and Medicaid Services announced its mailing strategy over the course ... Learn More

New Payment Model Qualifies as APM

The Centers for Medicare and Medicaid Services (CMS) is rolling out a new payment model to begin ... Learn More

MAO Provider Directories Frustrate Would-Be Patients, CMS Finds

In a review completed in August 2017, the Centers for Medicare and Medicaid Services (CMS) dis... Learn More

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New Rules Proposed for Quality-of-Care Complaints

March 2, 2011:

Currently, only beneficiaries who have been admitted to a hospital as inpatients are required to receive information about contacting their state QIO for any quality-of-care issues. This proposed new rule, along with information as to how to contact the local QIO, would be made a condition for participation in the Medicare program. The following health care settings would be affected by this proposal’s implementation:

  • Clinics, rehabilitation agencies, and public health agencies that provide outpatient physical therapy and speech-language pathology services
  • Comprehensive outpatient rehabilitation facilities (CORFs)
  • Critical access hospitals (CAHs)
  • Home health agencies (HHAs)
  • Hospices
  • Hospitals
  • Long-term care facilities (LTCFs)
  • Ambulatory surgery centers (ASCs)
  • Portable x-ray services
  • Rural health clinics/federally qualified health centers (RHCs and FQHCs)

Medicare has long contracted with private, mostly nonprofit organizations, such as QIOs, to ensure beneficiaries have access to high-quality, high-value health care. A QIO is located in each of the 50 states as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Further, each QIO has professionals on staff, consisting mainly of physicians and other health care professionals, specially trained to evaluate medical care and assist beneficiaries with quality-of-care complaints. QIO medical staffs are also trained to work directly with providers and facilities regarding quality improvements across all health care settings.

QIOs use information gathered from beneficiary complaint investigations as a key resource to recommend solutions and implement improvements in the quality of care received from Medicare participating providers and suppliers.

CMS is accepting comments on this proposed rule through April 3, 2011, and will respond to comments in a final rule to be issued in the months thereafter. More information on this topic can be found at http://www.cms.gov/qualityimprovementorgs.


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