In the nearly sixty years since Medicare and Medicaid were established, the two programs have become an indelible part of the safety net of American society, providing healthcare coverage for our most vulnerable citizens: the elderly, the disabled, and low-income families and individuals.
Much of IPRO’s work revolves around these programs. We work with state departments of health and the federal government to measure, monitor, and help improve the quality of care provided to Medicaid and Medicare enrollees across the various settings in which they access care.
The IPRO Quality Innovation Network–Quality Improvement Organization (QIN-QIO) is a collaboration of three organizations with decades of experience serving as Medicare QIOs. The collaboration is led by IPRO, and joined by two other established and respected Medicare QIOs: Healthcentric Advisors and Qlarant.
The IPRO HQIC quality improvement team of experienced healthcare professionals includes pharmacists, nurses, physicians, health informatics professionals, healthcare administrators, social workers, dietitians, and data analysts. Each member of our team brings expertise in implementing cross-setting quality improvement initiatives as well as established relationships with nationally recognized subject matter experts in all heath care topics, including patient safety, drug safety, and emergency preparedness.
The Centers for Medicare & Medicaid Services (CMS) relies on Network Organizations to develop relationships with dialysis professionals, providers, and patients and create a collaborative environment to improve patient care. IPRO’s ESRD Network Program operates four Networks.
The IPRO Patient Family Advisory Council (PFAC) provides a forum for ensuring that the voices of patients and family members are represented in a meaningful and substantial manner aligning with IPRO’s quality improvement activities. The PFAC brings together patients, family members, care partners, and patient advocates representing the diverse and multi-cultural populations of the healthcare communities in which we work.
IPRO works with more than 150 managed care plans (MCPs) across the country, performing the full breadth of mandatory and optional EQR activities and providing innovative solutions and best practices to help our state clients monitor and improve MCP performance.
IPRO has performed tens of thousands of reviews for medical necessity and appropriateness and has extensive experience handling appeals of denial of care and payment. IPRO makes objective determinations on appeals covering the full range of disputes among enrollees, providers, and health plans such as eligibility, contract interpretation, medical necessity, and experimental/investigational treatment.
States are responsible under Part C of the federal Individuals with Disabilities Education Act (IDEA), to ensure that infants and toddlers with disabilities receive the early intervention services afforded to them under state and federal law. State early intervention monitoring programs help to assure both the quality and value of these services.
Detecting and deterring fraud and abuse is a central issue in Medicaid program administration. States are responsible to protect the integrity of the program and prevent taxpayer dollars from ending up in the pockets of unscrupulous providers who believe that Medicaid crime pays. The compliance audit is an important weapon in every state’s arsenal for fighting Medicaid abuse and waste.
IPRO has extensive experience providing services that ensure that care rendered to patients is appropriate, necessary, and meets professionally recognized standards of care.
IPRO has been designated as a certified Independent Dispute Resolution Entity (IDRE) by the U.S. Department of Health and Human Services, the Department of Labor, and the Department of Treasury. This designation indicates that, as part of the No Surprises Act, IPRO may perform payment dispute resolution between providers or facilities and health plans for certain out-of-network services received by health plan enrollees.
Across nearly 100 state and federal programs in 32 states, IPRO makes creative use of clinical expertise, emerging technology, and data solutions to make the healthcare system work better.
HEADQUARTERS:
1979 Marcus Avenue
Lake Success, NY 11042-1072
Phone: 516-326-7767
Toll Free: 800-852-3685
Fax: 516-328-2310
TTY: 800-662-1220 or 711
