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  • CMS Launches Next Phase of New Quality Improvement Program
  • On July 18, CMS awarded additional contracts as part of a restructuring of the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs. 

    QIN-QIO projects will be based in communities, health care facilities and clinical practices. They will drive quality by providing technical assistance, convening learning and action networks for sharing best practices, collecting and analyzing data for improvement. HHS National Quality Strategy (NQS) and the CMS Quality Strategy provide the framework for the contracts along with the companion, recommendations, and priorities.

    Specifically, each QIN-QIO will work on strategic initiatives such as reducing healthcare associated infections, reducing readmissions and medication errors, working with nursing homes to improve care for residents, supporting clinical practices in using interoperable health information technology to enable the exchange of essential health information to improve the coordination of care, promoting prevention activities, reducing cardiac disease and diabetes, reducing health care disparities and improving patient and family engagement. QIN-QIOs will also provide technical assistance for improvement in CMS value based purchasing programs, including the physician value based modifier program.

    As a result of the changes, some hospitals and providers will now work with a different QIO than in the past. The new QIN-QIO contracts were competitively awarded. The restructured program will continue to ensure that the entire country participates in strategic initiatives and that local practices are considered. The first phase of the restructuring – which CMS announced on May 9, 2014 –allows two Beneficiary and Family-Centered Care (BFCC) QIO contractors to perform the program’s case review and monitoring activities separate from the quality improvement activities performed by QIN-QIOs. CMS will introduce the program changes with the beginning of its five year, 11th Statement of Work – the QIO contracts cycle – on August 1, 2014.

    Full text of this excerpted CMS press release (issued July 18) and information on the QIN-QIO awarded contracts. 

  • July 23 Webinar: Restructuring of Quality Improvement (QIO) Program

    Join the Centers for Medicare and Medicaid Services (CMS) - Center for Clinical Standards and Quality - for a discussion on the restructuring of Quality Improvement (QIO) Program effective August 1, 2014.

    CMS recognizes the unique impact of the changes on the provider community as it relates to areas such as provider’s procedures for notifying beneficiaries regarding rights to appeals of discharge determinations, addressing quality of care concerns, provision of medical records, working on quality improvement initiatives and receiving technical assistance on value and incentive programs.  The  purpose of this meeting is to share an overview of the QIO Program changes, provide an update on the transition process, discuss its impact on the provider community, share critical resources, and to answer any questions. We have scheduled this webinar for Wednesday, July 23, 2014 from 11:00 am – 12:00 pm EDT.

    Here is how you can join (Pre-registration is not required):


         Telephone Number: 1-877-267-1577

         MeetingPlace ID: 993 182 797 (This meeting does not require a password.)

        Webinar  (Users without an Adobe Connect log-in may sign-in as a guest)

           This session will be recorded.  Thank you for your participation in this call to advance health care quality for Medicare beneficiaries. CMS looks forward to hearing from you.

    • Delay in Implementing NCD for Single Chamber and Dual Chamber Cardiac Pacemakers: 3

      On August 13, 2013, the CMS issued a final decision memorandum regarding coverage of implanted permanent cardiac pacemakers, single chamber or dual chamber, and determined they are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. On February 6, 2014, CMS directed Medicare Administrative Contractors to implement national coverage determination (NCD) 20.8.3 on July 7, 2014, for claims with dates of service on and after August 13, 2013, for those beneficiaries who meet the specific coverage criteria. See MLN Matters® Article MM8525 (

      There is a temporary delay in implementing NCD 20.8.3. CMS will advise you of the new implementation date in the near future.

    • Upcoming CMS MLN Connects™ National Provider Calls
      For a description of a call, or to register, visit MLN Connects Upcoming Calls. Space may be limited, register early.
      • Thursday, July 10; 2:30-4:00pm Eastern Time: Dialysis Facility Compare: Rollout of Five Star Rating
      • Wednesday, July 16; 2:00-3:00pm Eastern Time: ESRD Quality Incentive Program: Reviewing Your Facility's PY 2015 Performance Data
      • Tuesday, July 22;  2;30-4:00pm Eastern Time: Open Payments (the Sunshine Act): Registration, Review, and Dispute
      • Wednesday, July 23; 2:00-3:30pm Eastern Time: ESRD Quality Incentive Program: Notice of Proposed Rulemaking for PY 2017 and 2018
      • Thursday, July 24; 1:30-3:00pm Eastern Time: 2015 Medicare PFS Proposals for PQRS, Value Modifier, EHR Incentive Program, and the Physician Compare Website
      • Tuesday, August 19; 1:30-3:00pm Eastern Time: National Partnership to Improve Dementia Care in Nursing Homes: Improved Care Transitions
    • On and After April 1, 2014, Medicare Will Accept Only the Revised CMS 1500 Claim Form (02/12)
      Medicare began accepting claims submitted on the revised CMS 1500 claim form (02/12) on January 6, 2014. Medicare will continue to accept claims submitted on the old CMS 1500 claim form (08/05) through March 31, 2014.However, on April 1, 2014, Medicare will accept professional and supplier paper claims on only the revised CMS 1500 claim form (02/12). On and after April 1, 2014, Medicare will not accept claims on the old CMS 1500 claim form (08/05). More information is available in the March 20 eNews.
    • Hospital Inpatient Admission Order and Certification; 2 Midnight Benchmark for Inpatient Hospital Admissions: CMS-1599-F Final Rule
      Feedback and questions on the two midnight provision for admission and medical review can be sent to  
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