Medicare Quality Review Services

As the Medicare Quality Improvement Organization (QIO), Oklahoma Foundation for Medical Quality (OFMQ) reviews patient cases under the Medicare Beneficiary Complaint Response Program and conducts other performance monitoring and assessment activities. These review services help ensure patients receive necessary care that meets acceptable quality standards. OFMQ can help providers improve quality where there is opportunity.

We review cases in virtually all health care provider settings for:

• Medical necessity, reasonableness, appropriateness
• Quality concerns
• Validity of diagnostic and procedural information
• Completeness and adequacy
• Medical and other practices

OFMQ uses InterQual® as our licensed review criteria. We will begin using the 2008 version for all May 2008 admissions. Please contact our case review manager if you have any questions.