July 24, 2014

CMS Splits Beneficiary Review from Quality Improvement Work for QIOs

The Centers for Medicare and Medicaid Services (CMS) have restructured the Quality Improvement Organizations (QIOs) as part of the 11th Scope of Work, separating the beneficiary review from the quality improvement and technical assistance previously provided by state QIOs. Through this restructuring, state organizations cannot perform both functions and the support will be provided by regional organizations. The medical case review will be performed by Beneficiary Family Centered Care Quality Improvement Organizations (BFCC-QIO) while the quality improvement and technical assistance will be provided by Quality Innovation Network Quality Improvement Organizations (QIN-QIOs).


The BFCC-QIOs are organized into five geographic regions and awarded the contract to KEPRO for 33 states and the District of Columbia and to LIVANTA for 17 states, Puerto Rico and the Virgin Islands. Florida was one of the 33 states awarded to KEPRO. The BFCC-QIOs will perform the quality of care reviews, medical necessity reviews, higher weighted DRGs, the readmission reviews and EMTALA investigations.


The QIN-QIOs will focus on excellence in operations, better health, better care, lower cost and technical assistance.  Last week, CMS awarded contracts to fourteen organizations to serve the 50 states plus DC, Puerto Rico and the Virgin Islands. HSAG, the parent company of FMQAI, was awarded the work for Florida, Arizona, California and Ohio.  The 11th Scope of Work starts Aug. 1.

FHA staff is scheduling trainings with HSAG (FMQAI) and KEPRO to ensure hospitals are aware of the changes and the work assigned to each organization. For more information, contact Kim Streit, vice president of healthcare research and information, at (407) 841-6230.