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Referral Reviews

QIOs are required to conduct quality reviews when complaints about Medicare beneficiaries' healthcare are received from sources other than the beneficiary. These referrals come from a variety of state and federal agencies and organizations, that include but are not limited to:
  • the Centers for Medicare & Medicaid Services (CMS)
  • the Office of the Inspector General (OIG)
  • Florida's Agency for Healthcare Administration (AHCA)
  • the Federal Bureau of Investigation (FBI)
  • the Centers for Health Dispute Resolution (CHDR)
  • the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • and Medicare fiscal intermediaries
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