Tag Archives: Quality Improvement Organizations (QIO)

CMS Ends Temporary Suspension of Hospital “Two-Midnight” Short Stay Reviews

CMS has announced that it is allowing Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs) to resume initial patient status reviews to determine the appropriateness of Part A payment for short stay inpatient hospital claims, effective September 12, 2016.  Such reviews had been “paused” since May 4, 2016 to promote consistent application of … Continue Reading

CMS Update on Temporary “Two Midnight” QIO Review Pause

CMS has temporarily “paused” Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations’ (QIOs) performance of initial patient status reviews under CMS’s “two-midnight policy” for short hospital stays. The pause, which took effect May 4, 2016, was a result of inconsistencies in the BFCC-QIOs’ application of the two-midnight policy and was intended to give CMS … Continue Reading

CMS Proposes $43 Million CY 2016 Medicare OPPS Rate Cut; Small Increase in ASC Payments

On July 8, 2015, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2016.  Perhaps most notably, CMS is proposing a -0.1% OPPS update for 2016, driven … Continue Reading

OIG Questions Potentially Duplicative Hospital Quality Improvement Efforts

The OIG recently issued a report that examined the extent to which Quality Improvement Organizations (QIOs) duplicate other CMS hospital quality improvement efforts, particularly Hospital Engagement Networks (HENs) and the Community-Based Care Transitions Program (CCTP). Based on a questionnaire sent to a random sample of 410 Medicare hospitals, more than half of responding hospitals reported … Continue Reading

CMS Announces Reforms to Quality Improvement Organization Program

On May 9, 2014, CMS announced it is implementing the first phase of its reforms to the Quality Improvement Organization (QIO) Program in an effort to “gain efficiencies, to eliminate any perceived conflicts of interest, and to better address the needs of Medicare beneficiaries.” Under this first phase, CMS has named two Beneficiary and Family-Centered … Continue Reading

CMS Requests Comments on QIO Service Areas

CMS is requesting public comments on how to define service areas for Medicare Quality Improvement Organizations (QIOs). Specifically, CMS wants input on four potential options CMS may use to divide work among a varying number of QIO contractors into service areas that are focused on quality-improvement-related work only. CMS is also seeking “fresh new ideas” … Continue Reading

CMS to Host Call on Future Development of the Quality Improvement Organization (QIO) Program (1/24)

On January 24, 2013, CMS is hosting a Special Open Door Forum on “Future Development of the Quality Improvement Organization (QIO) Program.” The call will address ways that QIOs, in partnership with CMS, can: maximize learning and collaboration in healthcare quality improvement and value with local, state, and regional organizations; demonstrate value to beneficiaries, patients, … Continue Reading

CMS Issues Proposed OPPS, ASC Policies for 2013

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update Medicare payment and other policies for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical centers (ASCs) for calendar year (CY) 2013. The proposed rule also would update Medicare inpatient rehabilitation facility (IRF) quality reporting program policies and … Continue Reading

CMS Proposes Requiring Providers to Notify Beneficiaries of Right to Access QIOs

CMS published a rule on February 2, 2011 that would require certain Medicare-certified providers and suppliers to inform their Medicare beneficiaries about their right to file written quality-of-care complaints with the local Quality Improvement Organization (QIO). The new standard would apply to: ambulatory surgical centers (ASCs); hospices; hospitals; long term care (LTC) facilities; home health agencies (HHAs); … Continue Reading

GAO Recommends Enhanced QIO Quality of Care Review Data

The GAO has issued a report to Congress highlighting the need for Medicare’s Quality Improvement Organizations (QIO) to provide consistent information to CMS regarding the costs associated with quality of care reviews. The GAO found that because of inconsistencies in QIO reporting, CMS cannot accurately assess the volume of QIOs’ quality of care reviews and the … Continue Reading

Quality Improvement Organizations (QIO) Responses to Beneficiary Complaints

The GAO has issued a report entitled “Quality Improvement Organizations’ Final Responses to Beneficiary Complaints.” By way of background, QIOs must review written quality-of-care complaints from Medicare beneficiaries and send to the beneficiary a final response summarizing their review findings. A practitioner involved in a case can decline to give consent for the QIO to identify him … Continue Reading