How to place a complaint to Medicare
How complaints and appeals are handled by Medicare is not a small matter. The Centers for Medicaid and Medicare Services have stated that they review more than 100,000 of these on a yearly basis. Almost 16,000 are filed by beneficiaries annually, which are related to hospital care while 18,000 are regarding nursing homes, hospice programs and home health services. Another 30,000 appeals and complaints are regarding Medicare Advantage programs.
A change however was made in the process with Medicare providing 2 numbers (toll-free) to be called on. It is likely that you must have received these numbers on forms which nursing homes or hospitals may have provided you with regard to your rights. If however your health care provider hasn’t caught up with the change, you may not have received these numbers.
These new numbers reflect a change which has occurred. Every state has a quality improvement organization which has worked until now with providers on issues such as reducing hospital readmission, preventing infections, expedited appeals and reviewing complaints. Some critics and beneficiaries however saw conflict of interest in this; could the organization which has given advice to the providers also review the complaints made against them? They thus recommended that these functions should be separated.
Thus beneficiary appeals and complaints now go to 2 large regional contractors which are officially known as Beneficiary and Family Centered Care Quality Improvement Organizations which is based in Maryland and which handles 9 Northeastern states and 8 states in the West along with Puerto Rico and the Virgin Islands. In Washington D.C and other states, a company by the name of KePro oversees the complaints made.
None of this would really matter to you if you were looking to contact Medicare because you believe that a hospital is letting you go home before you feel you’re strong enough to go or if you find that a home health aide has not behaved appropriately. For this purpose, a different number has been given to call on. However what is the number? The old Q.I.O numbers are required to direct you to either KePro or Livanta and while these do immediately direct the caller, it can only happen if you have the old numbers.
If you are looking to find the new numbers through Medicare.gov then you need to go on to the Medicare Helpful Contacts page, look on the select an organization menu and search for Quality Improvement Organization and then enter your state. This will then materialize the right number for Livanta or KePro. It is however much simpler to get the new numbers by consulting the state guide which has been posted by the United Hospital Fund.
This phone issue is likely to be sorted out soon but there are certainly time limits for filing for expedited appeals. Concern is thus justified and in real time, chances are that people are likely to be affected which is why it would be best if the issue gets sorted out sooner than later.