Accreditations and Certifications
One of the things that sets us apart from other organizations doing similar work is our independence. Just as healthcare organizations seek accreditation and validation of excellence through Joint Commission Accreditation, the Baldridge or Leap Frog quality designations, quality improvement organizations have the ability to seek similar certifications and recognitions. KFMC holds four of those:
URAC Independent Review Organization (IRO) Accreditation – URAC’s IRO accreditation standards validate that the organizations performing IRO services are committed to a fair and impartial medical peer review process that benefits both patients and physicians. This accreditation is designed to assure that Independent Review Organizations are free from conflicts of interest, establish qualifications for physicians performing independent medical peer review, address medical necessity and experimental treatment issues, and have reasonable time periods for standard and expedited peer reviews, and appeals processes.
Federally designated External Quality Review Organization (EQRO) – An External Quality Review (EQR) is the analysis and evaluation by an External Quality Review Organization (EQRO) of aggregated information on quality, timeliness, and access to the health care services that a managed care plan, or its contractors, furnish to Medicaid beneficiaries. EQROs are designated to perform independent and external validation of State Medicaid managed care programs’ adherence to federal regulations.
CMS Certified QIO-Like Entity (Quality Improvement Organization) – Organizations that are designed as Quality Improvement Organization (QIO)-like entities can perform two different, but similar, activities addressed in two separate sections of Federal Medicaid law. The Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ) reviews functions specified under Section 1154 of the Act related to the performance of medical necessity and quality of care review. QIO-like entities must be able to review cases and analyze patterns of care related to medical necessity and quality review.
CMS Designated Network of Quality Improvement and Innovation Contractor (NQIIC) – KFMC is one of only 59 organizations nationally, and the only Kansas-based organization, to receive designation as a Network of Quality Improvement and Innovation Contractors. NQIIC Contractors were awarded based on their demonstrated ability to affect large-scale, healthcare improvement. NQIIC Contractors help CMS empower doctors and patients to make health care decisions, support innovative ways to build up health quality, affordability and accessibility and improve the customer experience.