About alternative dispute resolution
Mediation and other approaches for complaints about quality of care
When a Medicare beneficiary has a complaint about the quality of care received under Medicare, Acumentra Health staff evaluates the complaint to determine whether it is suitable for alternative dispute resolution. If the case is suitable, an Acumentra Health case review manager contacts the Medicare beneficiary and the provider or practitioner to offer alternative dispute resolution for resolving the complaint.
Alternative dispute resolution is voluntary and it is free. The beneficiary always has the option to return to the traditional medical record review process if he or she does not believe that resolution has been achieved after alternative dispute resolution has been attempted.
About mediation
Mediation is one form of alternative dispute resolution. Mediation brings a Medicare beneficiary together with a provider (such as a hospital or nursing home) or a practitioner (such as a physician) for a face-to-face meeting facilitated by an impartial professional mediator. To proceed, both parties must agree to participate.
What happens in mediation
Either party can withdraw from the process at any time. If the parties agree to participate, a mediation session is conducted face-to-face, or by telephone. During the session, the mediator helps the parties reach an agreement or understanding.
Benefits of mediation
Mediation is intended to help patients and their healthcare providers understand each other’s point of view. Mediation often improves the relationship of those involved.
Download a fact sheet about review and mediation, with a diagram of the review process (printer-friendly PDF document)
Other forms of alternative dispute resolution
Facilitated resolution
In a facilitated resolution, Acumentra Health will designate a facilitator who will speak to the beneficiary and to the provider in separate telephone discussions. The facilitator serves as an intermediary to convey information from the beneficiary to the provider about the specific concern and what could have been done to prevent the complaint.
External resolution
External resolution occurs when, during the course of mediation or facilitated resolution, the provider or the beneficiary contacts the other party to discuss what might be done to resolve the complaint. External resolution addresses the issues without Acumentra Health's involvement.
More information
- Medicare website: www.medicare.gov
- Medicare beneficiary helpline:
1-800-MEDICARE
(1-800-633-4227) - Quality-of-care complaints:
1-855-472-4440
Fax: 1-855-472-4441 - Protect yourself from Medicare fraud
Last updated August 8, 2011