Memorandum of Agreement
| Ohio KePRO is the Quality Improvement Organization (QIO) authorized by the Medicare program to review medical services provided to Medicare beneficiaries in Ohio. As you may know, we review medical records to determine whether services delivered to these beneficiaries meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting. In addition, we review written complaints from Medicare beneficiaries about the quality of Medicare services they have received and conduct quality improvement projects to make measurable improvements in beneficiary health status or satisfaction. In order to participate in the Medicare program, certain providers are required under federal law to have a Memorandum of Agreement (MOA) with a QIO. MOAs outline the QIO’s and provider’s responsibilities during the review process. Section 1866 (a)(1)(E) of the Social Security Act requires providers of services to have an agreement with QIOs to release data related to patients when a QIO requests it. Section 1866 (a)(1)(F)(i) of the Social Security Act requires hospitals which provide inpatient hospital services paid under the Prospective Payment System (PPS) to maintain an agreement with QIOs to review the validity of diagnostic information provided by such hospitals, the completeness, adequacy and quality of care provided, the appropriateness of admissions and discharges, and the appropriateness of care provided for which additional payments are sought. Section 1866 (a)(1)(F)(ii) of the Social Security Act requires hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), hospices, LTACs, CORFs and home health agencies (HHAs) to maintain an agreement with a QIO to perform certain functions. The MOA describes (a) Ohio KePRO procedures with respect to certain contract obligations, (b) review and appeal rights providers have with respect to these obligations, and (c) opportunities providers have to partner with Ohio KePRO in local and national quality improvement projects. | In order to participate in the Medicare program, certain providers are required under federal law to have a Memorandum of Agreement (MOA) with a QIO." Download the Memorandum of Agreement (MOA) Manual  Download Provider Update Form  Return your signed MOA to: Ohio KePRO ATTN: Liz Paduano Rock Run Center, Suite 100 5700 Lombardo Center Drive Seven Hills, Ohio 44131 Please e-mail Elizabeth Paduano or call her at 216 447-9604, ext. 2222 with questions. | |
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