Optimal to Audit Qualified Independent Contractors (QICs) for CMS
For Immediate Release: February 2008
Optimal Solutions Group (Optimal) has been contracted by the Centers for Medicare & Medicaid Services (CMS) to evaluate the accuracy, timeliness, and quality of Qualified Independent Contractors’ (QICs ) decisions and processes. QICs conduct the second level of the Medicare appeals process, adjudicating reconsideration decisions for claims appealed by providers, beneficiaries, or suppliers after the claim has been denied by a Medicare Carrier, Fiscal Intermediary, or Medicare Administrative Contractor.
Optimal will conduct onsite audits at the six QICs to determine whether the QIC is performing their functions in accordance with the QIC contract requirements, and CMS rules, regulations, and policy guidance. Optimal will develop detailed protocols for measuring process management and the accuracy of coverage and medical decisions. The protocols will include the measures under review along with the data elements to support the measures. Optimal will develop an Access database to facilitate data collection onsite. Based on the information gathered, Optimal will develop evaluation reports, and provide a comprehensive performance report to CMS for all of the current QICs.
CMS is the Department of Health and Human Services (HHS) agency responsible for administering Medicare, Medicaid, and SCHIP (State Children's Health Insurance Program). For more information on CMS, visit www.cms.hhs.gov.
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Optimal Solutions Group, LLC is a nonpartisan, public policy research consulting firm in the Baltimore-Washington metropolitan area. Optimal is committed to supplying insightful program evaluation, cost-benefit and effectiveness analyses, custom econometric modeling, and market analyses for decision makers in both the public and private sectors.
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