Medicare QIO Requests for Review and Quality of Care Complaints

As a consumer you also have the right to ask MPRO, your local quality improvement organization (QIO), for a request for review of care decisions with which you do not agree. You may also choose to file a complaint.

You may request assistance in the following ways:

Hospital Discharge QIO Request for Review

You may request a Hospital Discharge QIO Review if you:

• Believe you are not medically ready to go home from the hospital;
• Have a legitimate medical reason to continue receiving a medical service;or
• Have not received clear discharge instructions.

Other QIO Requests for Review

You may request a QIO review from MPRO if you disagree with the decision of skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, or hospice to discharge you.

Quality of Care Complaints

If you believe you are not receiving the care you need, you have the right to file a quality of care complaint. Some common complaints include:

• Wrong medication;
• Unnecessary surgery or diagnostic testing;
• Inadequate care or misdiagnosis by any Medicare hospital or doctor;
• Early discharge from a health care facility.

To complete a Medicare Consumer QIO Request for Review or file a complaint:

For assistance please call 1-800-365-5899 (toll-free number)/

711(TTY users) 24 hours a day/ 7 days a week.