Specifically, the Beneficiary Complaint Response Program:

• Handles Medicare beneficiaries or their representatives complaints initiated in writing or by telephone
• Provides a case manager who works with the beneficiary from start to finish to keep the beneficiary informed throughout the review process about the status of their complaint
• Utilizes physician peer review to assess clinical quality of care issues in a patient’s record of care (referred to as Medical Record Review)
• Focuses on individual-based quality improvement efforts whereby an index case (e.g., an initiating concern) can lead to systems level quality improvements in future care rendered

Some of the typical complaints that beneficiaries file with a QIO may be for issues such as:

• Received the wrong medication
• Underwent inappropriate surgery
• Received erroneous dose of medication
• Experienced an error in treatment
• Received inadequate care or treatment by any healthcare professional
• Was discharged too soon
• Change in the condition was not treated
• Received inadequate discharge instructions

.

Contact the Beneficiary Complaint Response Program
Call 1-800-MEDICARe or your QIO.  You will be directed to an individual who will be able to walk you through the process that follows.

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MedQIC AHQA

Page Last Modified: 12/14/2005 12:00:00 AM
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