Hospitals

As part of our Medicare Quality Improvement Organization contract, Qualis Health provides the following types of services to Idaho and Washington hospitals:

• "Action Networks" focused on reducing healthcare-associated infections (HAIs) in Idaho and Washington.
   
• Evidence-based interventions designed to improve care transitions and reduce rehospitalizations on a community level. (Read about opportunities to participate in this work.)
   
• Training and consultation to meet data reporting requirements for Medicare's annual payment update and value-based purchasing initiative
   
• Medical case review in response to requests from Medicare or its beneficiaries (see below)
   

Medical Case Review

Qualis Health helps all Idaho and Washington hospitals respond to requests from Medicare, such as those related to:

• Beneficiary complaints
• Beneficiary appeals
• Medicare's physician acknowledgement monitoring
• EMTALA reviews
• HWDRG reviews

Hospitals are required to give advance notice to Medicare beneficiaries and members of Medicare Advantage plans before their inpatient care is terminated, and to inform them of their right to request an appeal. (Please help us keep our appeals-related contacts up to date.)

Finally, Qualis Health reviews Idaho and Washington requests for Medicare authorization to use an assistant at cataract procedures.