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Provider Information

Health Care Excel serves as the Medicare Quality Improvement Organization (QIO) for Indiana and Kentucky, under the direction of the Centers for Medicare & Medicaid Services (CMS). Goals and services provided by the QIO program are listed below.

Background

The goals of the QIO program are the following.

Improve health-care quality for people with Medicare, with a particular emphasis on underserved populations.
Safeguard the integrity of the Medicare program, including the trust fund, by ensuring payment is made only for reasonable, medically necessary services.
Protect the rights of Medicare beneficiaries by investigating complaints about quality of care and reviewing Hospital Issued Notices of Noncoverage (HINN) issued by hospitals.

Health Care Quality Improvement Program (HCQIP)

Through the HCQIP, the Medicare QIO collaborates with the medical and consumer communities to develop, conduct, measure, and evaluate health care quality improvement initiatives in a variety of settings. CMS chooses to focus priority areas in order to have an impact on the health of people with Medicare. Some of the priority areas include acute myocardial infarction (AMI), heart failure (HF), pneumonia (PNE), influenza immunizations, breast cancer (mammography), diabetes, surgical infection prevention (SIP), and underserved and rural populations. The initiatives include the Nursing Home Quality Initiative (NHQI), Home Health Quality Initiative (HHQI), Hospital Quality Initiative (HQI), and the Physician Practice Quality Initiative (PPQI).

Quality Improvement Initiatives

Quality Review Operations

Beneficiary Education

QIOs provide information and education to beneficiaries about health promotion, disease prevention, and beneficiary rights and responsibilities, as well as offer free educational materials on various health topics. QIOs also maintain a Medicare beneficiary helpline (1-800-288-1499) to assist beneficiaries by answering questions about the QIO program, including HINN, appeals, and quality-of-care concerns.

In the past, QIOs worked primarily with hospitals. Present and future health-care improvement efforts focus on managed care organizations, nursing facilities, home health agencies, and physician offices. QIOs employ physicians, nurses, health-care quality improvement professionals, epidemiologists, statisticians, and communications experts to support improvement efforts and achieve these goals.

For more information - Medicare Consumer

Partnerships

The Medicare QIO works with health-care provider associations, ministerial alliances, health-care coalitions, and other professional organizations to increase opportunities for provider and patient education. These partnerships are instrumental in efforts to increase opportunities for provider and patient education.