tci Medicare Compliance & Reimbursement - 2015 Issue 19

Medical Reviews: New Review Entities on the Horizon

CMS proposes switch. You’ll be getting medical reviews from a new entity for 2016. The Centers for Medicare & Medicaid Services (CMS) has proposed to switch from Medicare Administrative Contractors (MACs) to Quality Improvement Organizations (QIOs) to provide the first line medical reviews regarding questioned admissions. QIOs, private contractors charged with monitoring the quality of care provided to Medicare beneficiaries, are a good choice for first line reviews as they (in their various program incarnations), have generated a respectable track record across numerous clinical review issues for more than 30 years, says MichaelGranovsky, MD, FACEP, CPC, President of...

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