Quality Assurance

We provide systematic monitoring and evaluation to facilitate oversight of countless healthcare/public health projects, contracts, and services to help ensure quality. Staff knowledge is aided by extensive experience, training and a corporate emphasis on our quality management system.

Qsource’s first work was as a peer review organization, and we continue providing quality assurance for Medicare beneficiaries, and Medicaid and CHIP members. We assess compliance with documentation requirements, provide policy reviews and independent medical reviews to determine if services meet professionally recognized standards of healthcare quality, are medically necessary and are delivered in the most appropriate, cost-effective manner.

Medicare Case Review

Qsource improves the quality of care and services provided to Medicare beneficiaries through mandated case review activities. Medical records are reviewed for:

  • Quality of Care (appropriateness of setting, utilization, coverage),
  • Compliance with the Emergency Medical Treatment and Labor Act (EMTALA),
  • Beneficiary or Beneficiary Caregiver Requests (consider provider discharges or termination of health services and denials of hospital admissions), and
  • Diagnosis Related Group (DRG).

See Improving Healthcare for additional provider tools and resources or Protecting Medicare Beneficiaries for information on rights, complaints, appeals, dispute resolution and healthcare compare tools.

If you would like to become a Physician Advisor/Member for Qsource in Tennessee, apply online or you can download, complete and fax an application.

Medicaid Quality Review

Qsource conducts quality reviews to assist in oversight of Medicaid providers and managed care organizations, assuring confidence that their services meet requirements and providing technical assistance for improvement. Learn more about the external quality review, case review, retrospective and prior authorization review, and program evaluation and contract management work Qsource does for the