Health Care Excel is the Medicare Quality Improvement Organization (QIO) for Indiana and Kentucky.
What is a QIO?
The Centers for Medicare & Medicaid Services (CMS) contracts with one QIO in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands to serve as that state/jurisdiction's QIO contractor. QIOs are staffed by health care professionals who are trained to review medical care and assist beneficiaries with quality of care concerns, and implement clinical processes to improve care.
What does Health Care Excel do as a QIO?
We focus on three aims: better patient care, better population health, and lower health care costs through improvement. By law, we improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries that include the following core functions:
- Improve quality of care for beneficiaries focusing on high cost clinical topics that include hospital-acquired infections, health care-associated conditions in nursing homes, reducing adverse drug events and hospital readmissions;
- Protect the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and
- Protect beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.
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The Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and testing of innovative health care payment and service delivery models.