What should I do if I am not happy with the quality of care I am receiving from Medicare?

The Centers for Medicare & Medicaid Services (CMS) is working to make health care safer through its Quality Improvement Organization (QIO) Program.

According to the CMS website, this is what a QIO is:
QIOs are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. QIO contracts are 3 years in length, with each 3-year cycle referenced as an ordinal “SOW.”

According to the CMS website, this is what QIO’s do:
By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. Based on this statutory charge, and CMS’ Program experience, CMS identifies the core functions of the QIO Program as:
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; and
Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.

Consumers can learn more about how the QIO works in their specific state by visiting:
1) http://medicare.gov/contacts
2) Select “Do you want to find a specific organization?”, then click on “Find helpful contacts and websites”.
3) From there, in the dropdown, select QIO and then your specific state.

You should then be provided the state QIO organization name and phone numbers, and in most cases, a website.

With major changes in Medicare Advantage coming, quality care with basic Medicare is essential to the health of our nation.

Source: www.medicare.gov

April 7, 2011 8:07 pm Published by