quality improvement organization

What is a quality improvement organization?

A quality improvement organization (QIO) is a team of doctors and health care professionals who keep track of the quality of care received by Medicare patients. These experts review and investigate complaints, ensure that the care beneficiaries receive is reasonable and medically necessary, critique the decision-making policies of providers, and review the quality of facilities within the Medicare program.¹

QIOs are categorized as BFCC-QIOs (Beneficiary and Family Centered Care-Quality Improvement Organizations) or QIN-QIOs (Quality Innovation Network-Quality Improvement Organizations), depending on what they do:²

• BFCC-QIOs are focused on reviewing Medicare beneficiaries’ care and responding to complaints from beneficiaries about the quality of their care. BFCC-QIOs are also the team that handles appeals (expedited reviews) when a beneficiary is being discharged from a hospital or outpatient care program and the patient believes that their care and coverage should continue (the patient will receive a Detailed Notice of Discharge, or a Detailed Explanation of Non-Coverage, respectively).
• QIN-QIOs work with medical providers and community organizations to improve the quality of care that Medicare beneficiaries receive.
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