|
Mediation is a new option to resolve a quality of care complaint under Medicare. This is at no direct cost to the beneficiary. It is a dialogue between the beneficiary and his or her doctor or hospital, facilitated by an impartial third person (the mediator). It is an opportunity for the beneficiary and his or her doctor or hospital to tell their story, respond to each other, and resolve the concerns about the way the beneficiary was treated. Not all complaints are appropriate for mediation. A QIO physician reviewer determines if the case is suitable to be resolved by both parties. Mediation Process Mediation is a form of conflict resolution that brings two parties together in a process conducted by an impartial third party (the mediator). Mediation is a process that often results in increased satisfaction to the participants. It is not a binding arbitration. Participation is voluntary. By its very nature, mediation is a process in which the parties willingly decide to participate. One or more of the parties may need to be persuaded, but it is the eventual consent of the parties that gives the mediator the authority to work with them; there is no other basis for that authority. Qualification Guidelines QIOs have two methods for resolving clinical quality of care beneficiary complaints. The first is through the process of Medical Record Review and the second is through Mediation. While mediation conceivably can be used to resolve any type of healthcare issue, mediation in the Medicare setting will initially deal with perceptions of clinical quality of care issues and communication. If the beneficiary or their representative declines the offer of mediation, the case will revert to the traditional medical record review process. Both methods of resolving beneficiary complaints will be offered free of charge. Examples of Suitable Cases for Mediation - The beneficiary says they were given the wrong medicine, and the medical record shows the medicine was correct, but the instructions given were not clear or completely understood.
- The beneficiary's representative states his or her parent was discharged before he or she was able to walk. The medical record shows that the patient could walk with assistance, physical therapy in the home was ordered, but the family did not understand what arrangements had to be made to start the care at home.
- The beneficiary states that the care received from an orthopedist for neck pain did not help her. The medical record shows that the physician discussed a variety of available options for care. However, the beneficiary did not make a choice and did not return for a follow-up visit.
Page Last Modified: 12/14/2005 12:00:00 AM
Help with File Formats and Plug-Ins
Submit Feedback
|
Email
Print