Which entity is authorized by CMS to perform utilization and quality control review of health care for Medicare beneficiaries?

Prepare for your Health Insurance Billing Exam. Utilize flashcards and multiple choice questions, each with explanations. Boost your readiness!

The correct choice refers to Quality Improvement Organizations, commonly known as QIOs. These entities are specifically authorized by the Centers for Medicare & Medicaid Services (CMS) to oversee the utilization and quality control review of healthcare services for Medicare beneficiaries. Their primary role is to ensure that patients receive appropriate care and that healthcare providers adhere to established standards of quality.

QIOs perform various tasks, including reviewing medical records, evaluating the necessity of treatments, and providing feedback to healthcare providers. They aim to monitor and enhance the quality of care delivered to Medicare beneficiaries, making them a critical component of the healthcare system.

The other entities listed serve different functions within the healthcare framework. For instance, the American Medical Association (AMA) primarily works on advocating for physicians and advancing medical practice and standards but does not review utilization and quality of care for Medicare. Professional Review Organizations (PROs) were predecessors to QIOs and have been incorporated into the QIO system, thus no longer existing as a separate entity. Medicare Administrative Contractors (MACs) focus on administering Medicare claims and managing payment, not directly overseeing quality control.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy