Annual Medical Services Review Report

All Medicare Quality Improvement Organizations (QIOs) produce an Annual Medical Services Review Report, which includes the number of Medicare beneficiary complaints reviewed in their state. Acumentra Health is the Medicare Quality Improvement Organization for Oregon.

The Annual Medical Services Review Report includes

• reviews of all written quality-of-care complaints from a Medicare beneficiary or representative
• immediate reviews of Hospital-Issued Notices of Noncoverage (HINNs), if review is requested by a Medicare beneficiary or representative
• immediate reviews of Medicare Advantage plan-issued Notice of Discharge and Medicare Appeal Rights (NODMARs) in a hospital setting, if review is requested by a Medicare beneficiary or representative
• fast-track reviews of Medicare Advantage plan-issued Notices of Medicare Non-Coverage (NOMNCs) issued by a skilled nursing facility or by a home health agency, if review is requested by a Medicare beneficiary or representative
• expedited reviews of Medicare fee-for-service Notices of Medicare Provider Non-Coverage (NOMPNCs) issued by a skilled nursing facility, home health agency, or hospice, if review is requested by a Medicare beneficiary or representative

From August 1, 2007, through July 31, 2008, Acumentra Health completed reviews on 39 quality complaint cases. For calendar year 2006 (the most recent data available), Oregon had 542,089 Medicare Part A beneficiaries, and at the time of this report, Acumentra Health reviewed less than 1 complaint case per 10,000 Part A Medicare beneficiaries.