How Do I File a Medicare Quality-of-Care Complaint?
Short answer
Quality-of-care concerns can be raised through the appropriate Medicare quality complaint process, including plan grievance channels and BFCC-QIO review for qualifying concerns.
Coverage And Action
Document what occurred, dates, clinicians/facilities and the resulting harm or concern. Use the channel that matches the setting and issue.
Not Automatic
A quality complaint does not replace an appeal seeking continued services or reversal of a coverage denial.
Practical Example
Unsafe discharge concerns may create a quality complaint while a separate fast-appeal process may apply if covered services are ending too soon.
Questions to verify
- Is the concern about care quality or coverage?
- Is a fast appeal also available?
- Which organization has jurisdiction?