Expedited reviews: Are you ready for the QIO's call?
Billing Alert for Long-Term Care, July 1, 2009
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Mastering SNF beneficiary notices isn’t easy, and expedited reviews add an extra challenge to the notification process: tight deadlines.
The expedited determination process gives Medicare beneficiaries the right to a quick appeal by a Quality Improvement Organization (QIO) when Medicare-covered items or services are discontinued. The process can be beneficial for SNFs because it shifts the burden of decision-making to a neutral third party, and the QIO’s decision cannot be challenged or overturned by a Medicare reviewer.
When a resident requests an expedited review, SNFs must be prepared to respond quickly by submitting all the required medical records to the QIO. For a disorganized or unprepared SNF, an expedited review could be chaotic
This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.
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