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A quality improvement organization (QIO) works to improve health care provided under Medicare and to make sure it's cost-effective. There are more than 50 QIOs serving all 50 states, DC and territories. QIOs work under contract with the federal Centers for Medicare & Medicaid Services. Many of them hold contracts for similar work for state Medicaid programs and waivered programs. QIOs bid competitively for these contracts.
The three main priorities for QIOs, as determined by CMS, include patient safety (reducing medical errors); prevention (of illness, avoidable hospitalization and so forth); and beneficiary protection (educating people about their rights under Medicare and how to make the most of their coverage, as well as handling complaints and quality-of-care concerns).
One way many people hear about their QIO is during a hospital stay. If you're on Medicare, you should receive a "notice of noncoverage" before you are discharged from the hospital. It just means that if you continue to stay after a certain amount of time, Medicare will not pay. The notice tells you who to call if you feel you still need hospital care or if you have a concern about the quality of your care.
You can find out more at www.medicare.gov or you can Google your state and "QIO" or "quality improvement organization."
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