Annual Medical Services Report

12210 - Annual Medical Services Report (Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16) For QIOs that perform case review, the communication plan should provide the means to transparently disseminate the QIO’s review findings and comply with the statutory responsibility to publish and distribute not less often than annually, a report that describes a QIO’s medical services review findings as required by Section 1154(a)(6)(B)(ii) of the Act. The QIO Annual Report, subject to prior-approval of the CMS Contracting Officer’s Representative, disseminates findings where the QIO has determined that: • inappropriate or unnecessary care was provided • services were furnished in inappropriate settings; or • services did not meet professionally recognized standards of care in its service area(s). The Annual Report must include statistical data that does not implicitly or explicitly identify any individual patients, practitioners, or reviewers, and must not contain confidential information as defined in 42 CFR 480.101. The Annual Report must not report any case-specific or summary statistical information on cases that a QIO referred to the Office of the Inspector General (OIG) or to any other federal or state agency responsible for identifying and investigating fraud and abuse.