Ensuring Medicare beneficiaries receive appropriate, necessary healthcare that meets professionally recognized standards has long been a goal of the QIO program.  As part of the beneficiary protection program, CIMRO of Nebraska conducts statutorily mandated review activities that include:

• Reviewing the quality of care provided to Medicare beneficiaries
• Reviewing beneficiary appeals of certain provider notices
• Reviewing potential anti-dumping cases; and
• Implementing quality improvement activities as a result of case review activities.

CIMRO of Nebraska utilizes a number of tools to address beneficiary’s concerns, including implementation of quality improvement activities (QIAs), surveying of beneficiary satisfaction with the complaint process and outcome, and, if appropriate, alternative dispute resolution (ADR) mechanisms.

The CIMRO of Nebraska Beneficiary Protection/Case Review team consists of experienced and qualified physicians, nurses and licensed healthcare professionals.  Physician Reviewers provide expertise in case review activities including utilization, quality and beneficiary complaints and appeals.  All CIMRO of Nebraska Physician Reviewers hold unrestricted Nebraska medical licenses and are in active practice in the provision of care to Nebraska Medicare beneficiaries.