Which statement best describes the primary function of a QIO?

• A. Private for-profit company that audits hospitals
• B. Enforce EMTALA compliance in hospitals
• C. Provide direct medical care to Medicare beneficiaries
• D. Review complaints about care and implement changes for Medicare patients

Answer: (D)

QIOs are focused on quality improvement for Medicare patients. Their main job is to review the care that beneficiaries receive, assess complaints about care quality, and work with providers to implement changes that improve outcomes and safety. They aren’t private auditors of hospitals for profit, they don’t enforce EMTALA, and they don’t give direct medical care to patients. Instead, they act as CMS contractors that analyze care quality, identify gaps, and drive system-wide improvements to Medicare care.