Beneficiary Protection

Under the Centers for Medicare & Medicaid Services (CMS) 9th Scope of Work, quality improvement organizations such as HSAG will continue to carry out the following statutorily mandated review activities:

• Reviewing the quality of care provided to beneficiaries
• Reviewing beneficiary appeals of certain provider practices
• Reviewing potential antidumping cases
• Implementing quality improvement activities as a result of case review

Individual patient complaints and provider medical record reviews are important starting points for analysis of quality improvement needs among providers. During the next three years, HSAG will be increasing its efforts to link case review activities to improvements in the quality of care by developing quality improvement activities focused on system-wide changes. HSAG will use all data related to case review activities to identify problems related to the quality of care and will design quality improvement activities aimed at helping providers correct these problems.

If you are a provider and would like more information on HSAG's beneficiary protection initiatives, please click here.

If you are a Medicare beneficiary and would like more information on HSAG's beneficiary protection initiatives, please click here.

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