tci Medicare Compliance & Reimbursement - 2003 Issue 27

QIOs: COURT: QIOS MUST TELL COMPLAINING SENIORS MORE

A Medicare quality improvement organization must tell a complaining beneficiary, at a minimum, whether or the QIO believes the beneficiary's treatment met "professionally recognized standards of health care." So said a unanimous three-judge panel of the U.S. Court of Appeals for the D.C. Circuit in a June 23 opinion, which affirmed a 2001 trial court decision that had been stayed pending appeal. The court was construing a provision of the Social Security Act stating that a QIO - the law and the court use the older term "peer review organization" - "shall inform the individual (or...

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