General Quality of Care Review: Preparing the General Quality of Care

5110 – General Quality of Care Review: Preparing the General Quality of Care Review Folder: Intake – Stage One (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) NOTE: The QIO referenced in this section refers to a qualified staff member as a QIO designates. The job title may differ within each QIO. A QIO is responsible for preparing the General Quality of Care Review folder/file. Should a copy of the folder/file be needed (e.g., for use by an off-site Peer Reviewer), a duplicate copy of the folder/file may be prepared. CMS expects that the folder/file will be forwarded to the QIO within one (1) business day of receiving a referral or identifying a potential Quality of Care Concern as a result of tracking and/or trending of data. In instances where a Quality of Care Concern is identified during other review activities, the QIO will prepare/organize the information necessary to enable the Quality of Care Review to be completed in addition to the original review activity. For example: In completing an expedited discharge appeal review, the Peer Reviewer identifies a Quality of Care Concern. A QIO should establish procedures to enable the Reviewer who identified the Quality of Care Concern to complete the Quality of Care Review.