For state Medicaid programs, state health departments, and other public-sector healthcare entities, every budget dollar matters. What many state administrators do not realize is that engaging a QIO-like Entity unlocks a specific federal reimbursement rule that effectively turns one state dollar into four dollars of impact. The rule is simple, well established, and frequently overlooked. The Rule, in Plain Terms Section 1903(a)(3)(C) of the Social Security Act is direct on this point: "75%...

If you work in healthcare, you have probably heard the term "QIO-like entity." It sounds technical. The idea behind it is actually simple, and understanding it can help your organization meet quality, compliance, and cost pressures with far less strain. A QIO-like entity gives healthcare organizations access to the same quality improvement and oversight expertise that supports federal Medicare programs, with the flexibility to work directly with private providers and payers. This article...

Two terms shape nearly every conversation in healthcare administration: Fee for Service and Program Integrity. They are often confused, and just as often misunderstood. Understanding how they work together is essential for any provider, payer, or public program that wants to deliver care responsibly. At HealthSkil, our nearly 30 years of healthcare expertise as a certified QIO-like Entity guides our approach to Fee for Service and Program Integrity. We have seen what happens when the two are...