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Medicare and Quality Improvement Organizations (QIOs)

Medicare and the Quality Improvement Organizations (QIOs) (the fiscal and quality intermediaries for Medicare on a state basis) are very quickly developing strategies to limit "over payment" for short stay admissions and what they consider "medically unnecessary" services.

Historically Medicare has "over paid" for admissions with the chief complaint of "Chest Pain", "Abdominal Pain" and "Asthma".

In fact Medicare has developed Observation Status that provides higher payment for these groups of patients to incent hospitals to treat these patients in a lower cost area. This was done to prevent the admission of these patients for 1-2 days and then receive a full DRG payment. The state QIOs under mandate by Medicare will be scrutinizing "over payment" for all short stays.