Overlap of Review Authority

5090 – Overlap of Review Authority (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) QIOs may receive referrals of potential Quality of Care Concern(s) from other sources, agencies, or entities (e.g. other QIOs, public or private review organizations, Medicare contractors such as MACs), when the referring source or entity identifies what may be a quality concern related to Medicare services while conducting a review based on its jurisdictional requirements [See §476.160(a)]. Pursuant to 42 CFR §476.104, QIOs must work with these organizations to ensure any necessary coordination. QIOs are responsible for ensuring that organizations, including contractors, have clearly defined direction about the types of cases that warrant referral to the QIO.