CMS Announces Changes for the QIO Program

The Centers for Medicare & Medicaid Services (CMS) is implementing changes to the Quality Improvement Organization (QIO) program beginning in August. Recently, CMS announced that Livanta, LLC, and KePRO have been awarded the contracts for the Beneficiary and Family Centered Care QIOs and will have primary responsibility for conducting case review functions, such as complaint reviews, quality of care reviews, discharge appeals, higher weighted diagnostic related groups (DRG) requests and Emergency Medical Treatment and Active Labor Act (EMTALA) reviews.
 
What does this mean for you? Beginning August 1, 2014, VHQC will no longer support Medicare case review activities; KePRO will take on this role in Virginia and 32 other states. Providers do not need to take any immediate action.
 
While VHQC will no longer manage Medicare case review activities in Virginia, VHQC intends to continue supporting improvement activities as a Quality Innovation Network (QIN) QIO. QIN-QIOs will be responsible for collaborating with providers, practitioners and the community on multiple data-driven quality initiatives to improve patient safety, reduce harm, and improve clinical care at the local, regional and national levels.
 
QIN-QIO contracts will be announced in July; work will begin in August.