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.
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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) 503-5783 with questions.
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