Protecting the Quality of Care Under Medicare
Through the Quality Improvement Organizations (QIO) Program, Medicare provides a way for consumer voices to be heard. Qsource, Tennessee’s QIO, provides direct assistance to Medicare beneficiaries when they have concerns about medical quality or believe healthcare services are being discontinued too soon. We are independent, objective and a trusted partner of organizations that advocate for Medicare beneficiaries. Qsource empowers beneficiaries to participate in health care decision-making and take an active role in managing their own health. We encourage beneficiaries to share their experiences as patients; this will help us improve care and safety.
Qsource works to improve the lives of Medicare beneficiaries as we:
- Review the quality of care covered by Medicare;
- Perfom QIO review of appeals of certain provider notices about discharge or discontinuation of services;
- Review potential cases of patient “dumping”;
- Implement quality improvement activities to address concerns identified in the course of medical record review.
Medicare is currently making some changes to the program. Soon the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) will be the QIO that will manage all beneficiary complaints and quality of care reviews to ensure consistency in the case review process while taking into consideration local factors important to you and your family. Quality Innovation Network (QIN) QIOs will be responsible for working with providers and the community on multiple, data-driven quality initiatives to improve patient safety, reduce harm, and improve clinical care at their local and regional levels.
Quality Case Review and Appeals after July 31st
- Beginning Friday, Aug.1, 2014, Medicare beneficiaries must contact the new Beneficiary and Family Centered Care (BFCC-QIO) KEPRO toll-free at 1-844-430-9504 for all appeal requests and Quality of Care concerns. On that date, all Medicare beneficiary quality review case work and appeals for Tennessee will be conducted by KEPRO .
- These changes are part of the Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization program transformation effort to further enhance the quality of services to Medicare beneficiaries.
- If your case is currently under review or in process, please be assured that every effort has been made to ensure a seamless transition for Medicare beneficiaries with no disruption in case review services.
To avoid processing delays and errors, please continue submitting cases and requests to Qsource through 4:30 p.m. CDT Thursday, July 31, 2014 using the current process.
This page is paid for by our Medicare QIO Program Contract.