Our work with Medicare

One of AFMC’s primary responsibilities is serving Medicare as a Quality Improvement Organization (QIO). In this role, AFMC works under contract with the federal Centers for Medicare & Medicaid Services to improve and ensure the effectiveness, efficiency, economy and quality of services delivered to Arkansans who are on Medicare.

QIOs across the nation are charged with:

• Improving the quality of care for people on Medicare
• Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and medically necessary and that are provided in the most appropriate setting
• Protecting those on Medicare by speedily addressing individual complaints, notices and appeals, including beneficiary complaints; provider-issued notices of non-coverage (Hospital-Issued Notice of Non-Coverage [HINN], Notice of Discharge and Medicare Appeal Rights [NODMAR] and Medicare Advantage appeal); and Emergency Medical Treatment and Labor Act (EMTALA) violations

8th Statement of Work
AFMC and the entire QIO program recently completed the 8th “statement of work” contract cycle (August 2005 – July 2008).  AMFC and other QIOs worked under this contract cycle to improve care in all settings and many clinical areas. To find out more, visit the quality improvement sections for providers in physician offices, hospitals, nursing homes, home health agencies and schools.

9th Statement of Work
The QIO program is currently in the 9th three-year contract cycle with Medicare (August 2008 – July 2011). Under the 9th statement of work, AFMC is focusing on three main themes: Beneficiary protection, patient safety and prevention. All QIOs will also help Medicare promote the adoption of value-driven health care; support the adoption and use of health information technology; and reduce health disparities in their communities.

As part of this new contract cycle, QIOs are required to offer help to specific nursing homes and hospitals that have not recently performed well on important quality measures.