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How to Complain to Medicare

The Centers for Medicare and Medicaid Services says that it reviews more than 100,000 complaints and appeals every year. Beneficiaries of the programs file around 16,000 complaints relating to hospital care and discharge orders as well as 18,000 complaints against nursing homes, home health services, and hospice programs. Another 30,000 complaints and appeals are specifically geared towards the Medicare Advantage programs. How Medicare handles its complaint and appeals process is no trivial matter, and the program has recently revised its complaint process.

Updated Medicare Complaint Process

On August 1, Medicare made a change to its complaint filing system: it added new, toll-free numbers to call to lodge a complaint. The new phone numbers represent a larger change in the Medicare complaint system. Each state used to have a quality improvement organization, or Q.I.O. Up until August 1, these organizations worked with providers on issues like hospital readmissions or preventing infections, reviewed beneficiary complaints, and expedited appeals.

However, experts saw a major conflict of interest issue with the Q.I.Os – could an organization that advised providers also be able to fairly review complaints against them? In order to prevent any perception of bias, Medicare has set up a new system to handle complaints. Now, complaints and appeals go to two large regional contractors known as Beneficiary and Family-Centered Care Quality Improvement Organizations, or B.F.C.C. Q.I.Os.

One of the main goals of the new system is to transition seamlessly for the beneficiaries. The only difference is that there is a new number to call. However, finding that new number and accessing the information about the new system is not as easy as Medicare would have you believe.

How to Find the Information

Some Medicare beneficiaries have received the new phone numbers when visiting a hospital or through their nursing home service, but many other providers have not informed their beneficiaries of the change. If you have the old number, dialing it will automatically redirect you to one of the new regional contractors. But what if you do not have the number, or have never called in a complaint to Medicare before?

There are a couple of different resources available to help you find the new information regarding Medicare complaints and appeals, but you must know where to look in order to find it. If you are looking for the new phone numbers in the Medicare.gov website you must first go to the Medicare Helpful Contacts Page, look down the “select an organization” menu for “Quality Improvement Organization (Beneficiary and Family Centered Care),” then enter your state.

Another way to find the new information is to look at the state by state guide provided by the United Hospital Fund. The organization has posted the correct phone number for each state because it was concerned about the number of Medicare beneficiaries that did not know about or how to access the new phone numbers for the program. The concern is justified because there is a limited deadline for certain types of Medicare appeals, and people can be affected by this change in real time.

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