CMS needs to improve QIOs' reporting of cost, volume related to quality-of-care reviews

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The Centers for Medicare & Medicaid Services cannot be certain that it is budgeting accordingly for Quality Improvement Organizations' (QIOs) quality-of-care reviews because of potential reporting errors. That is a according to a report released this week by the Government Accountability Office.

The GAO found inconsistencies among some QIOs in the ways they record certain volume and cost information in CMS's Case Review Information System (CRIS) and CMS's Financial Information and Vouchering System (FIVS). CMS has not established clear instructions for how QIOs should record volume and cost information in these systems, the report said. CMS contracts with QIOs, which are private organizations, to improve Medicare beneficiary care.

Sens. Max Baucus (D-MT) and Chuck Grassley (R-IA), who released the report, said better guidelines would help ensure proper Medicare payments.

“CMS has to do a better job of tracking this work so it can pay the appropriate amount and so taxpayers get what they're paying for, which is better quality of care for Medicare beneficiaries,” Grassley said in a statement.