Beneficiary & Family-Centered Care

Beneficiary & Family-Centered Care

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.

As we carry out these activities, Qsource works to assure that proper care guidelines are followed in all cases. Sometimes this requires us to coordinate with groups such as the Department of Health and Human Services’ Office for Civil Rights. For instance, Qsource works with this group when we suspect that care may have been compromised or denied because of discrimination on the basis of race, color, national origin, disability or age.

In addition, we maintain a beneficiary helpline to provide callers with information concerning Medicare beneficiary rights and responsibilities, beneficiary protections, and the various QIO programs and initiatives. QIO helplines are staffed during normal business hours and record calls received at other times. If you or someone you know has a concern about the quality of care received under Medicare, please contact 1-800-MEDICARE.

Finally, Qsource also protects Medicare beneficiaries by: ensuring that hospitals have a physician acknowledgment statement on file for physicians who bill for hospital services; helping CMS measure how satisfied beneficiaries are with QIOs when making a complaint; and reporting about all of the medical record reviews we conduct.

Ask Medicare

Caring for an older relative or friend who is ill can be overwhelming. That’s why the Centers for Medicare & Medicaid Services (CMS) created Ask Medicare, a campaign that provides support resources to caregivers of Medicare beneficiaries. At Ask Medicare, you can:

  • Learn about the Medicare program
  • Review benefits and coverage options
  • Find healthcare providers such as physicians, nursing homes and long-term care facilities
  • Find answers to billing questions
  • Locate financial, legal and local support

 

This page is paid for by our Medicare QIO Program Contract.