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QIO LiaisonThe individual who is selected to serve as the Quality Improvement Organization (QIO) Liaison will be responsible for receiving notices and communications from NMMRA regarding its medical record review activity, will coordinate the dissemination of such information within the facility, and will discuss with the QIO any questions, needs and suggestions regarding day-to-day interactions between the parties. Designation of the QIO Liaison may be changed by a facility at any time by notification to NMMRA in writing. The QIO Liaison is responsible for accomplishing the following tasks, or ensuring that the facility has someone trained to carry out the following responsibilities. General ResponsibilitiesExpedite requests for medical records, whether from the QIO or the Clinical Data Abstraction Center (CDAC). An untimely response will result in a technical denial, and the facility will not get paid for the claim. Distribute written communications to the appropriate department, or administrative leader, in a timely manner. - Help to coordinate responses between the practitioner and provider.
- Provide additional information, as warranted, to the QIO relating to specific issues.
- Understand that deadlines and due dates are mandated by the Centers for Medicare & Medicaid Services (CMS) and not NMMRA.
- Notify NMMRA in a timely manner if there is any change in contact information. (Note: All changes to contact information must be made in writing. See above link.)
- Facility name, address, phone number
- Administrator name and contact information
- QIO Liaison name and contact information
- Medicare provider number
Memorandum of Agreement (MOA) ResponsibilitiesBe informed of MOA content and details. Maintain accurate MOA information. Know who the contact people are at your facility, including, but not limited to: Utilization Review (UR)/Case Management (CM) Health Information Management (HIM)/Medical Records Physician Advisor Compliance Officer Quality Improvement Manager
Hospital-Issued Notices of Non-Coverage (HINN) ResponsibilitiesWork with case managers/discharge planners to facilitate the following: Assure accurate content of HINN notices Explain to the beneficiary, the QIO role in the appeal process Assist the beneficiary in calling for an appeal if needed Timely shipment of the medical record and HINN notice to NMMRA Provide a phone number for the attending physician Provide the liaison direct phone number or name and number of designee
Complete the HINN log for acute care, long-term care, swingbed, and mental health units (if applicable) and send to NMMRA on a monthly basis, regardless of whether a HINN was issued that month or not. Obtain and send any other reports to be submitted to NMMRA.
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