CMS Pub. 100-10, ch. 12
Table Of Contents (Rev. 27, 07-08-16)
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16)
This chapter describes the minimum requirements and responsibilities of QIOs for communications and outreach. QIO Program communication, outreach, and information collection activities must comply with the following statutory and regulatory responsibilities as applicable based upon the QIO functions, care settings, types of reviews, and service areas defined by CMS in each QIO contract:
CMS provides QIO contractors with program guides and handbooks that it routinely updates and revises as the program environment and operations change. The QIO Program Communications Handbook and the QIO Program Brand Guidelines Manual provide QIO Program contractors information regarding communications, outreach, information collection, and development of publications. QIO Program guides also direct QIO contractors to agency and departmental resources such as the CMS Contractor Website Guidelines and federal accessibility standards to comply with Section 504 and Section 508 of the Rehabilitation Act of 1973. CMS expects QIOs to use these guidance documents as a reference for operational questions not addressed in the QIO Manual. The QIO Program Communications Handbook and the QIO Program Brand Guidelines Manual are available to QIO contractors through the CMS-furnished secure Intranet site (secure log in is required).
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16)
QIOs conduct a variety of communications and outreach activities that may include positioning the organization as a resource to the public in support of case review functions and quality of care improvement initiatives, in addition to outreach efforts that support specific contract requirements. CMS contracts require QIOs to maintain a communication plan outlining the specific beneficiary communication and outreach activities it will conduct to educate beneficiaries, providers, and other non-QIO organizations working in the same service area(s) about the QIO Program, the exercise of beneficiary rights, and coordination of quality program activities.
For QIOs that perform case review, the communication plan shall also address planned outreach activities to comply with the statutory responsibility for physician/provider meetings required by Section 1154(a)(6)(B)(i) of the Act and Annual Reports required by Section 1154(a)(6)(B)(ii) of the Act.
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16)
For QIOs that perform case review, the communication plan should provide the means to transparently disseminate the QIO's review findings and comply with the statutory responsibility to publish and distribute not less often than annually, a report that describes a QIO's medical services review findings as required by Section 1154(a)(6)(B)(ii) of the Act.
The QIO Annual Report, subject to prior-approval of the CMS Contracting Officer's Representative, disseminates findings where the QIO has determined that:
The Annual Report must include statistical data that does not implicitly or explicitly identify any individual patients, practitioners, or reviewers, and must not contain confidential information as defined in 42 CFR 480.101. The Annual Report must not report any case-specific or summary statistical information on cases that a QIO referred to the Office of the Inspector General (OIG) or to any other federal or state agency responsible for identifying and investigating fraud and abuse.
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16)
QIOs that perform case review are required to maintain a toll-free helpline, operated according to QIO contract requirements, to handle beneficiary complaints, provide beneficiary support, and coordinate with providers and practitioners. QIOs must publish and promote both their own helpline as well as the national 1-800-MEDICARE helpline for all information related to beneficiary rights and responsibilities, protections, and various programs and activities.
QIOs should provide information regarding Medicare beneficiary rights and responsibilities, beneficiary protections (including Hospital-Issued Notices of Noncoverage [HINNs], Medicare discharge notices, discharge planning, and beneficiary complaints), and appropriate health education issues related to active projects. QIOs should make appropriate referrals when information or assistance inquiries are outside of the assigned scope of QIO activities or responsibilities.
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16)
QIOs promote practices that meet professionally recognized standards and promote improvements in the quality of health care provided to Medicare beneficiaries. One tactic that QIOs use to accomplish this goal is the implementation of cooperative quality improvement projects. As part of such projects, CMS encourages QIOs to develop innovative approaches that include collaborative efforts with the medical community, use of evidence-based interventions to change behavior and improve care, communication with beneficiaries and providers, and monitoring of the health care services furnished to beneficiaries.
The QIO Program Communications Handbook is a resource for guidelines and procedures on outreach and information collection requirements, including compliance with statutory and regulatory responsibilities, to support QIOs in developing and evaluating quality of care and quality improvement interventions. The QIO Program Communications Handbook is available to QIO contractors through the CMS-furnished secure Intranet site (secure log in is required).
| Rev # | Issue Date | Subject | Impl Date | CR# |
|---|---|---|---|---|
| R27QIO | 07/08/2016 | QIO Manual Chapter 12 – “Communications, Outreach, and Program-related Information Activities” | 07/08/2016 | N/A |
| R7QIO | 08/15/2003 | Initial Issuance of Chapters | N/A | N/A |
Back to top of chapter