How IPRO Protects You
IPRO is the not-for-profit Medicare Quality Improvement Organization (QIO) for New York State. We are not a health plan. In our role as the New York QIO, we work to educate and empower Medicare beneficiaries and their family/caregivers through education about healthcare quality. We also work with healthcare providers like doctors, hospitals and nursing homes to make sure they are giving you the quality care you need at the right time and in the right way, every time you need care.
IPRO offers educational workshops and resources to empower you and make sure you are better informed when you or a family member need to make important healthcare decisions.
We share with you evidence-based self-management techniques that can help you take an active role in managing your own health.
We work to remove the socioeconomic, educational and cultural barriers that can prevent all beneficiaries from having equal access to quality healthcare.
We act as an independent, objective and a trusted partner of organizations that advocate for Medicare beneficiaries.
Know Your Rights
IPRO will help you understand your rights as a patient and make sure your voice is heard when you have problems with the care you receive.
Visit our Know Your Rights page to find out about your rights as a Medicare Beneficiary.
If you feel you have not received appropriate care, you can file a complaint about the quality of care you have received. We can help you file a complaint with us or we can refer you to the right agency to resolve your concern. Visit our File a Complaint page to learn more.
If you do not agree with a health care provider's notice that your care will no longer be covered or if you are concerned about a premature discharge, you can call us to review your case. Visit our Appeal a Discharge page to learn more.
Tell Us about Your Care Experience
IPRO wants to learn from your experiences receiving health services so we can both use them to educate other beneficiaries and help healthcare providers deliver more patient-centered care. Visit our Contact Us page if you would like to report a complaint or appeal a discharge or provider-issued non-coverage notice. Sharing your experience can help improve care for everyone in the future.
Annual Medical Review Reports
In accordance with our CMS QIO contract, IPRO publishes a Medicare, "Annual Medical Services Report" that provides information in regard to our processing of Medicare beneficiary quality of care complaints and appeals.
The quality of care complaints come from Medicare patients and/or their representatives. In reviewing a complaint, IPRO looks at the services a patient received and decides whether those services met standards of health care that are commonly accepted by physicians and others in the medical community.
Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-For-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. Once a patient or their representative asks IPRO to review a provider issued notice, IPRO conducts a review and issues either a denial notice or a notice explaining that the care would be, or is, covered. In all reviews, IPRO looks carefully at the patient's medical record to decide if an admission or continued stay or care is/was needed.
Annual Report 2012
Annual Report 2011
Annual Report 2010
Annual Report 2009
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM6-12-19.