Complaints can concern care received in the following settings:
- Hospitals and hospital emergency departments
- Ambulatory surgery centers
- Rehabilitation facilities
- Skilled nursing facilities
- Home health agencies
- Physician offices
Quality Insights is authorized to review two types of quality care complaints: immediate and retrospective. Quality Insights does an immediate quality review, which is also known as a concurrent review, when care places the patient in immediate danger. Quality Insights must complete its initial review within 24 hours of receiving the complaint and medical record.
When Quality Insights receives a complaint after the patient has been discharged, the review can take from three to six months. More information about concurrent and retrospective reviews is in the Quality Improvement Organization Manual.
Quality Insights also offers mediation and other forms of Alternative Dispute Resolution to resolve complaints that arise out of miscommunication and misunderstandings but don’t involve quality of care.
Follow this link for more information about mediation.
For more information, call 1-866-475-9669.