Certified Professional Coder (CPC) Practice Test

Which provider receives reimbursements for Medicare from the fiscal intermediary?

1. Physician's Office

2. QIO

3. Hospital Facility

4. Primary Care Provider

The correct answer is: QIO

The correct choice pertains to the role of a Quality Improvement Organization (QIO), which is a group contracted by Medicare to review the quality of care provided to Medicare beneficiaries. QIOs play a crucial role in ensuring that healthcare providers meet certain standards and can influence reimbursements based on the quality of services provided. Understanding the context, while various providers such as hospitals, physicians' offices, and primary care providers offer healthcare services and are reimbursed by Medicare, it is the QIO's function to ensure compliance and quality, which can affect the reimbursement process indirectly. The fiscal intermediary handles payments and claims processing, and the QIO interacts with them to maintain quality control over the services rendered, which, subsequently, can impact reimbursement rates and practices for other facilities and providers.