Quality Improvement Organization Manual 
Chapter 12 - Communications, Outreach, and Program-
related Information Activities 
 
Table Of Contents 
(Rev. 27, 07-08-16) 
 
Transmittals for Chapter 12 
 
12100 - Authorities 
12200 - Beneficiary Support and Outreach Activities 
12210 - Annual Medical Services Report 
12220 - Beneficiary Helpline 
12300 - Outreach and Information Collection  12100 - Authorities 
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16) 
 
This chapter describes the minimum requirements and responsibilities of QIOs for 
communications and outreach.  QIO Program communication, outreach, and information 
collection activities must comply with the following statutory and regulatory responsibilities as 
applicable based upon the QIO functions, care settings, types of reviews, and service areas 
defined by CMS in each QIO contract: 
 
  Maintain a beneficiary outreach program to apprise providers of healthcare services and 
individuals receiving care of their rights to QIO case reviews, and of a QIOs obligation 
for making review determinations as authorized by Section 1154(a)(1) and 1154(a)(4) of 
the Social Security Act (the Act) 
 
  Provide a physician representing a QIO to meet several times a year with medical and 
administrative staff of hospitals whose services are reviewed by the QIO as required by 
Section 1154(a)(6)(B)(i) of the Act 
 
  Publish and distribute not less often than annually a report that describes the QIOs 
review findings as required by Section 1154(a)(6)(B)(ii) of the Act  
 
  Coordinate activities for economical and efficient operation of the program as required 
by Section 1154(a)(10) of the Act 
 
  Conduct activities deemed necessary for improving the quality of care as required by 
Section 1154(a)(18) of the Act 
 
  Perform communication and outreach activities in accordance with the confidentiality 
and nondisclosure requirements defined in 42 CFR 480 and sections of the Health 
Insurance Portability and Accountability Act (HIPAA) 
 
CMS provides QIO contractors with program guides and handbooks that it routinely updates 
and revises as the program environment and operations change.  The QIO Program 
Communications Handbook and the QIO Program Brand Guidelines Manual provide QIO 
Program contractors information regarding communications, outreach, information collection, 
and development of publications.  QIO Program guides also direct QIO contractors to agency 
and departmental resources such as the CMS Contractor Website Guidelines and federal 
accessibility standards to comply with Section 504 and Section 508 of the Rehabilitation Act of 
1973.  CMS expects QIOs to use these guidance documents as a reference for operational 
questions not addressed in the QIO Manual.  The QIO Program Communications Handbook and 
the QIO Program Brand Guidelines Manual are available to QIO contractors through the CMS-
furnished secure Intranet site (secure log in is required). 
  12200 - Beneficiary Support and Outreach Activities 
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16) 
 
QIOs conduct a variety of communications and outreach activities that may include positioning 
the organization as a resource to the public in support of case review functions and quality of 
care improvement initiatives, in addition to outreach efforts that support specific contract 
requirements.  CMS contracts require QIOs to maintain a communication plan outlining the 
specific beneficiary communication and outreach activities it will conduct to educate 
beneficiaries, providers, and other non-QIO organizations working in the same service area(s) 
about the QIO Program, the exercise of beneficiary rights, and coordination of quality program 
activities. 
 
For QIOs that perform case review, the communication plan shall also address planned 
outreach activities to comply with the statutory responsibility for physician/provider meetings 
required by Section 1154(a)(6)(B)(i) of the Act and Annual Reports required by Section 
1154(a)(6)(B)(ii) of the Act. 
 
12210 - Annual Medical Services Report  
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16) 
 
For QIOs that perform case review, the communication plan should provide the means to 
transparently disseminate the QIOs review findings and comply with the statutory responsibility 
to publish and distribute not less often than annually, a report that describes a QIOs medical 
services review findings as required by Section 1154(a)(6)(B)(ii) of the Act. 
 
The QIO Annual Report, subject to prior-approval of the CMS Contracting Officers 
Representative, disseminates findings where the QIO has determined that: 
 
  inappropriate or unnecessary care was provided 
  services were furnished in inappropriate settings; or  
  services did not meet professionally recognized standards of care in its service area(s). 
 
The Annual Report must include statistical data that does not implicitly or explicitly identify any 
individual patients, practitioners, or reviewers, and must not contain confidential information as 
defined in 42 CFR 480.101.  The Annual Report must not report any case-specific or summary 
statistical information on cases that a QIO referred to the Office of the Inspector General (OIG) 
or to any other federal or state agency responsible for identifying and investigating fraud and 
abuse. 
 
12220 - Beneficiary Helpline 
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16) 
  QIOs that perform case review are required to maintain a toll-free helpline, operated according 
to QIO contract requirements, to handle beneficiary complaints, provide beneficiary support, 
and coordinate with providers and practitioners.  QIOs must publish and promote both their own 
helpline as well as the national 1-800-MEDICARE helpline for all information related to 
beneficiary rights and responsibilities, protections, and various programs and activities.  
 
QIOs should provide information regarding Medicare beneficiary rights and responsibilities, 
beneficiary protections (including Hospital-Issued Notices of Noncoverage [HINNs], Medicare 
discharge notices, discharge planning, and beneficiary complaints), and appropriate health 
education issues related to active projects.  QIOs should make appropriate referrals when 
information or assistance inquiries are outside of the assigned scope of QIO activities or 
responsibilities. 
 
12300 - Outreach and Information Collection 
(Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16) 
 
QIOs promote practices that meet professionally recognized standards and promote 
improvements in the quality of health care provided to Medicare beneficiaries.  One tactic that 
QIOs use to accomplish this goal is the implementation of cooperative quality improvement 
projects.  As part of such projects, CMS encourages QIOs to develop innovative approaches that 
include collaborative efforts with the medical community, use of evidence-based interventions to 
change behavior and improve care, communication with beneficiaries and providers, and 
monitoring of the health care services furnished to beneficiaries. 
 
The QIO Program Communications Handbook is a resource for guidelines and procedures on 
outreach and information collection requirements, including compliance with statutory and 
regulatory responsibilities, to support QIOs in developing and evaluating quality of care and 
quality improvement interventions.  The QIO Program Communications Handbook is available 
to QIO contractors through the CMS-furnished secure Intranet site (secure log in is required). 
 
  Transmittals Issued for this Chapter 
 
Rev #  Issue Date  Subject  Impl Date  CR# 
R27QIO  07/08/2016  QIO Manual Chapter 12  Communications,  07/08/2016  N/A 
Outreach, and Program-related Information 
Activities 
R7QIO  08/15/2003  Initial Issuance of Chapters  N/A  N/A 
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