Annual Report of Medicare Case Reviews

Acumentra Health serves Oregon Medicare beneficiaries as Medicare’s Quality Improvement Organization (QIO) for Oregon. The Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services (DHHS), awards QIO contracts in every U.S. state and territory. The national QIO Program is a major force and partner for continuous improvement of health and health care for all Americans, achieving national quality goals through a network of QIOs that convene local communities for learning and action. QIOs ensure the quality, effectiveness, efficiency, and economy of healthcare services provided to people with Medicare.

As a QIO, Acumentra Health protects the rights of Medicare beneficiaries by reviewing records and information when individuals or their representatives have concerns about the quality of their care or feel that their Medicare healthcare services are being ended too soon. Beneficiaries are entitled to:

  • File a complaint about the quality of health care they are receiving or have received in the past.
  • Appeal a decision to release the beneficiary from the hospital when the beneficiary or the family feels hospital care needs to continue.
  • Appeal a decision to end a course of treatment (such as rehabilitation, nursing home care, home health, or hospice care) when they feel they still need those services.

This Annual Report provides data regarding medical case reviews Acumentra Health has completed on behalf of Oregon Medicare beneficiaries.

From July 1, 2011, through June 30, 2012, Acumentra Health completed a total of 1,437 reviews on behalf of Medicare beneficiaries receiving care in Oregon. This includes reviews on 101 quality complaint cases and 694 appeals of notices of noncoverage of Medicare services. View the report for additional details regarding our reviews and Quality Improvement Activities with Oregon healthcare providers.

Download Oregon’s Annual Report of Medicare Case Reviews (PDF)

 

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Contact

  • Stacy Moritz
    Director of Medicare Quality Services
    Acumentra Health
    2020 SW Fourth Avenue, Suite 520
    Portland, OR 97201
  • Phone: 503-382-3918
    Fax: 503-279-0190
    Email: smoritz@acumentra.org

Last updated March 1, 2013