Medicare Case Reviews

As part of our Medicare Quality Improvement Organization contract, Qualis Health is mandated to perform case reviews on behalf of Medicare and its beneficiaries in Idaho and Washington. Referrals for review come from a variety of sources including beneficiaries, CMS, fiscal intermediaries, managed care organizations, and many others.

Federal laws control the types of reviews we conduct, as well as the methods we use to complete them. (See the Medicare Quality Improvement Organization Manual for details.) Our review team helps ensure that people with Medicare coverage receive the healthcare they are entitled to, and that the care they receive meets nationally recognized quality standards.

Our reviews must be completed within tight timeframes. To facilitate our review-related communication with your hospital, please help us maintain an accurate contact database by submitting any changes regarding the personnel designated as your official QIO Contact or Discharge Appeals Contact.

Learn more about our hospital case reviews:

• EMTALA reviews
• HWDRG reviews