Beneficiary and Family Centered CareFMQAI champions beneficiary and family centered care by promoting responsiveness to beneficiary and family needs, providing opportunities for listening to and addressing beneficiary and family concerns, providing resources for beneficiaries and caregivers in decision-making and using information from individual experiences to improve Medicare’s entire system of health care. The key to this concept is protecting the fiscal integrity of the Medicare Trust Fund while ensuring the beneficiary’s right to an expedited review, especially when the concern regards a pending hospital discharge or termination of skilled services.
FMQAI further protects Medicare beneficiaries’ rights to question their discharge from a hospital or termination of services from a skilled nursing facility or home health agency. This protection is accomplished through the following appeal processes:
- Hospital Discharge Notices - process for Medicare beneficiaries enrolled in the original Medicare plan to appeal a discharge from the hospital
- Expedited Determinations - process for Medicare beneficiaries enrolled in the original Medicare plan, and members of a Medicare Health plan to dispute termination of Medicare-covered services from a skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation center
- Emergency Medical Treatment and Labor Act
- Quality of Care Reviews
- Higher-Weighted Diagnosis-Related Group
- Provider Discharges/Service Terminations
- Hospital Admission Denials
- Physician Acknowledgement Monitoring and Assistants at Cataracts (as directed by CMS)
FMQAI provides technical assistance to beneficiaries, providers, physicians, and practitioners when performing reviews by providing findings from medical record review that identify the need for technical assistance related to CMS measures across provider settings. Our staff helps to develop interventions for provider/physician practices that address systemic, confirmed concerns while also sharing the use of best practices and proven methods to improve healthcare quality and reduce costs.
Watch our Medicare Minutes video to learn more about how the QIO Program supports Medicare Beneficiaries.