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Medicare contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands to serve as that state/jurisdiction’s Quality Improvement Organization (QIO) contractor. Primaris serves Missouri.
Learn more about the QIO program at the official site for the Centers for Medicare & Medicaid Services.
QIOs review medical care, help beneficiaries with complaints about the quality of care, and run quality improvement projects chosen by the Centers for Medicare & Medicaid Services (CMS). QIO contracts are 3 years in length.
What do QIOs do?
By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. CMS identifies the core functions of the QIO Program as:
- Improving quality of care for beneficiaries;
- Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable, necessary and provided in the most appropriate setting; and
- Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.
Why does Medicare have QIOs?
CMS relies on QIOs to improve the quality of health care for all Medicare beneficiaries. Furthermore, QIOs are required under Sections 1152-1154 of the Social Security Act. Throughout its history, the program has been instrumental in advancing national efforts to motivate providers in improving quality, and in measuring and improving outcomes of quality.
Participation in Primaris Quality Improvement Projects is confidential by federal law. Primaris can disclose only a very limited amount of information about project participants without prior written consent.