|
Medicaid Services
Medicaid Services
|
QIOs provide external
quality review services and technical assistance in quality improvement for state
departments of health across the country. These services include:
- Quality improvement
systems for Medicaid (and Medicare) managed care
- Internal quality
management and improvement
- Disease prevention
and health promotion services
- Beneficiary education
and provider outreach
- Quality of care
review
Observation review
Ambulatory
surgical treatment center review
Acute care
service review
Long-term care
service review
Transportation
service review
Home health
service review
Nursing service
review
Drug utilization
review
- Utilization management
services in hospitals, skilled nursing facilities, home health care, mental health
facilities, and rehabilitation treatment services.
- Utilization review
services
- Medical records
review and management
- Management of
access, prior certification and authorization for admissions
- Information systems
consulting
- Quality assessment
and performance improvement studies for Medicaid health plans.
- Client satisfaction
surveys, often using the Consumer Assessment of Health Plans Survey (CAHPS) developed
by the federal Agency for Healthcare Research and Quality.
- Case management
services
- Credentialing
and re-credentialing
- Retrospective
admission and continued stay review
- DRG/coding validation
|
|
