Medical Record Review

As the Medicare Quality Improvement Organization (QIO), OFMQ reviews medical records to address clinical quality of care complaints. Our experienced case reviewers and a pool of Oklahoma-based physicians participate in the review process to determine if the quality of care met professionally recognized standards.

When quality of care issues are identified, the physician-reviewer determines the source and severity of the issue and whether an improvement plan is needed. OFMQ engages the provider in researching and responding to the complaint. The beneficiary will not know the details of the review if the physician or provider does not agree to release this information.

The review process could take three to six months to complete, during which OFMQ informs the beneficiary or representative about the progress of the review. When the review is complete, OFMQ notifies the complainant of the final decision.