As the Quality Improvement Organization (QIO) for Maryland, Delmarva works to improve the overall quality of care for Medicare beneficiaries residing in Maryland.

Under the 9th Scope of Work (SOW), Delmarva will continue to carry out statutorily mandated review activities, such as:

Reviewing the quality of care provided to beneficiaries, including beneficiary complaints
Reviewing beneficiary appeals of certain provider notices;
Reviewing potential anti-dumping cases; and
Implementing quality improvement activities as a result of case review activities

Delmarva links Medicare case review activities to the development of system-wide improvements in quality of care. Case review activities ensure the quality of care provided to Medicare beneficiaries meets professionally recognized standards of care, is medically appropriate, and is cost effective. Specifically, Delmarva utilizes all data provided by review of beneficiary complaints to identify widespread problems and design quality improvement activities aimed at helping all providers address these issues.

Delmarva aims to improve the quality of care for Medicare beneficiaries by completing case reviews, sanction activities, physician acknowledgement monitoring, and quality data reporting. A strong focus for Delmarva involves the utilization of Alternative Dispute Resolution (ADR) techniques in appropriate beneficiary complaint cases. ADR, which includes mediation, facilitated resolution, and external resolution, is an effective approach to helping beneficiaries resolve disputes by providing beneficiaries with an opportunity to work with a third party mediator in resolving issues to the satisfaction of the beneficiary and the provider.

Delmarva also manages a beneficiary complaint hotline for Maryland Medicare beneficiaries (1-800-MEDICARE). This quality of care hotline provides assistance to Medicare beneficiaries who have complaints or who wish to appeal a Medicare denial of services, and offers information regarding beneficiary rights, as well as various Delmarva sponsored programs and activities.

Delmarva’s role as the QIO for Maryland is not only to protect the rights of the beneficiary, but to also protect the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services.

For more information about this initiative, contact Karen Mesko, Director, Quality Improvement Programs, meskok@dfmc.org, 410-763-6288.