Feds Change Quality Finding Disclosure Policy

CMS is clarifying a key change in how QIOs like IPRO are directed to handle Medicare quality of care complaints lodged by patients and their families. Previously, QIOs were barred from disclosing the details of adverse findings against physicians or practitioners without the permission of the physician or practitioner in question.  The new process, effective for complaints received on or after February 1, 2014, follows from a final ruled published last fall in The Federal Register, which was meant to increase the transparency of the QIO beneficiary complaint review policy. Under the new procedure, physicians and practitioners will still be afforded the opportunity to discuss a potential finding of substandard quality and will still be able to request a formal reconsideration review prior to a QIO’s sharing of detailed adverse findings with patients and families.  But once a decision has been made to go forward with adverse findings, Medicare beneficiaries will receive specific information on each concern initially raised by the beneficiary or beneficiary representative. Beneficiaries are also permitted to request detailed information on closed cases in which complaints were received after January 2, 2013. The change in policy is outlined in IPRO’s Internal Administrative Memorandum #2014-02, which is available on the IPRO website at www.ipro.org.