- Being given the wrong medication or medications that interact in a negative way.
- Not receiving treatment after abnormal test results.
- Being given the wrong blood when a transfusion is ordered.
- Sustaining a serious injury resulting from a fall while in a nursing home or hospital.
- Being improperly evaluated for a problem and because of this you did not receive the treatment you needed.
- Being given the wrong treatment or treatment that you did not need.
- Developing bed sores due to poor skin care.
- Being restrained physically or chemically in a nursing home.
- Name on Medicare card
- Medicare number
- Phone number
- Date of birth
- Name, address, and phone number for the health care provider
- Date the service was provided
Your Review Team A nurse review coordinator is identified as your point of contact throughout the review process. He or she works with you and keeps you informed of progress in the case. The nurse review coordinator is also the point of contact for your healthcare provider.
Ohio KePRO also matches a doctor from its statewide physician review network whose specialty matches your unique needs. The doctor addresses quality of care concerns with your healthcare provider and reviews your medical records. He or she looks at all aspects of care surrounding your complaint, and makes an initial finding, which is shared with the healthcare provider that your complaint is related to.
Why File a Quality of Care Review? The purpose of a quality of care review is to find the reason why things happened to cause your concern and to determine the likelihood that it will happen again. The purpose of a quality of care review is not to punish your doctor, but to help improve care delivery for future patients. In cases where chances are high that the scenario will happen again, the Ohio KePRO Review Team will help your healthcare provider make changes in procedures to prevent future problems.
How Long Does A Review Take? A typical review takes about three months. If the reviewer needs more time to answer questions about the care you received, the review can take up to six months.
If you feel you have not received quality health care from a provider of Medicare services such as those mentioned above, you may call Ohio KePRO at
1-800-589-7337 and ask for a review of your medical record.