Home Health & Hospice

Q: What is a QIO and what is their role in the homecare industry?

Homecare Insider, May 13, 2013

Q: What is a QIO and what is their role in the homecare industry?

A: QIOs are private, mostly nonprofit organizations staffed by professionals (doctors and other healthcare workers) who are trained to review medical care, assist Medicare patients who have complaints about the quality of care, and implement improvements in the quality of care. QIOs are contracted by CMS, and there is one QIO for each state, including Washington, DC; Puerto Rico; and the U.S. Virgin Islands. QIO contracts last three years.

QIOs are required under Sections 1152-1154. CMS relies on QIOs to help improve the quality of healthcare. According to CMS, the program has been "instrumental in advancing national efforts to motivate providers in improving quality, and in measuring and improving outcomes of quality."

According to CMS, the mission of QIOs is to improve the effectiveness, efficiency, economy, and quality of services delivered to beneficiaries. CMS states that the core functions of the QIO program are:

  • Improving quality of care for beneficiaries
  • Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting
  • Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints, provider-based notice appeals, violations of the Emergency Medical Treatment and Active Labor Act of 1986, and other related responsibilities as articulated in QIO-related law

For more information regarding QIOs, visit their dedicated Web page on the CMS website at www.cms.gov/QualityImprovementOrgs.

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