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QIO TRANSMITTAL SERIES ISSUE: Requests for Summary QIO Review Results Data - Printable
pages The Foundation often receives requests
from hospitals for data summarizing review results; most commonly, this
information is requested in conjunction with annual hospital audits being
conducted by outside parties. In the past, the QIO contract required
the Foundation to produce quarterly statistics summarizing review
results. The purpose of producing
these statistics on a quarterly basis was to identify areas for
intensification of review efforts. However,
since the current scope of QIO work focuses on quality improvement, it does
not provide for an intensified review sample based on quarterly statistics;
thus the Centers for Medicare & Medicaid Services has directed QIOs to
discontinue producing these quarterly reports. Because the Foundation no longer
produces this sort of summary information on a routine basis, requests from
hospitals for such data require the Foundation to generate special,
non-routine data reports and therefore must be treated as data requests. Such requests are subject to a charge to
cover the cost of generating and providing the non-routine data. Written requests for any data reports must
be submitted to the Foundation. The
Foundation will then advise the hospital of the associated cost and the
requested data will be generated after receipt of payment. The
Foundation supplies hospitals with copies of notices in every case in which
the Foundation has: · Denied any reimbursement (including concurrence
with hospital issued notice of noncoverage), · Required a change to the original DRG on a
Medicare claim, or · Confirmed a quality of care concern. Many hospitals currently maintain
internal systems to track and document QIO review results for
themselves. The Foundation suggests
that all providers consider adopting internal mechanisms which will allow
them to respond to auditors' requests on their own. November
2002 Next
Chapter: Review
of the Use of An Assistant at Cataract Surgery |
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Copyright © 2005 Northeast Health Care Quality Foundation, all rights
reserved |
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