Mediation
Mediation is when you and your doctor settle a dispute with the help of a third party known as a mediator. We offer mediation to resolve a dispute between you and your doctor about your care.
Medicare sponsors the national mediation program. Mediation has been used to resolve divorces, labor relations, and environmental disputes, but Medicare is one of the first in the health care industry to offer it in addition to the traditional medical record review process.
Quality Insights will review your complaint to determine whether mediation is an option. If it is, the review case manager will ask you if you want to use mediation instead of medical review.
In order to get started, you and your doctor must agree to mediation. Mediation is when you and your doctor discuss your complaint with the aid of a trained mediator. You can meet in person, or you can talk on the phone if you have a disability or a long way to travel. The meeting takes about two to four hours.
The CMS Web site includes the following sections about beneficiary complaints and mediation:
Beneficiary Complaint Response Program Overview
Resolving Complaints
Mediation
Mediation Background
Mediation Questions and Answers