These links will cover topics pertaining to Medicare beneficiaries and their rights, along with new services Medicare offers.Medicare Minutes will also provide tips and update health issues of concern to Medicare beneficiaries and their caregivers.
Mediation: New Option for Resolving Beneficiary Complaints
What is mediation?
Mediation is a new option to resolve a quality of care complaint under Medicare. This is at no direct cost to you. It is a dialogue between you and your doctor or hospital, facilitated by an impartial third person (the mediator). It is an opportunity for you and your doctor or hospital to tell your story, respond to each other, and resolve your concerns about the way you were treated.
How will I know if my complaint is appropriate for mediation?
Not all complaints are appropriate for mediation. An Ohio KePRO physician reviewer determines if the case is suitable to be resolved by both parties.
What are the key features of a mediation session?
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The session is facilitated by a professional, impartial third person (the mediator).
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The session is usually conducted face-to-face but can also be conducted over the telephone. It typically takes two to four hours.
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The session is strictly confidential. The discussion is not documented and cannot be used in any legal proceedings.
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You and your physician/provider determine the solution to your complaint.
Can I bring someone with me to the mediation?
Yes, if agreed to by the other party, you may bring a family member or designated representative to the mediation. You may also be provided with a mediation advisor, who is a trained professional that can answer your questions about the mediation process.
How will mediation affect my relationship with my doctor or healthcare plan?
Participants often report improved relationships after the mediation session. If your doctor or provider agrees to participate, he/she is also committed to improving communication.
I am interested in the mediation option, what do I do?
Call Ohio KePRO's Medicare Beneficiary Help Line at 1-800-589-7337. You will be directed to an individual who will be able to walk you through the process that follows. Keep in mind that not all complaints are suitable for mediation and you and your doctor or hospital representative must agree to participate in mediation before moving forward.
How does mediation affect my benefits under Medicare?
Participation is voluntary. If you choose not to participate your benefits under Medicare are not affected.
For more information on how mediation may be used to resolve your complaint, call Ohio KePRO at 1-800-589-7337.
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Important Message From Medicare
When you are admitted to a Medicare participating hospital, you will receive many forms to read. As a Medicare beneficiary, you will also receive a notice called An Important Message From Medicare.
This message tells you:
1. Your rights while you are a hospital patient.
2. What to do if you are being discharged from the hospital before you feel well enough to go home.
Federal law requires the hospital to give you this message. You or a family member should read it carefully and ask for help if there is something that you do not understand.
This message explains that you have the right to call Ohio KePRO to request a review of your case if you think you are not ready to be discharged from the hospital. The message also includes Ohio KePRO's address and toll-free helpline number as well as an explanation of how to obtain a review of your case.
Ohio KePRO is the quality improvement organization (QIO) for Medicare in Ohio, protecting the rights and health of Ohio's 1.8 million Medicare beneficiaries. Beneficiaries or anyone acting on their behalf can call our Helpline toll-free at 1-800-589-7337.
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Fast Facts about Medicare Health Insurance
What should you do if you believe you are being discharged from the hospital too soon?
If you believe you are being discharged too soon from a hospital, you have the right to immediate review by Ohio KePRO, the quality improvement organization for Medicare in Ohio. You may stay in the hospital at no charge and may not be discharged before Ohio KePRO makes a decision.
For more information about Medicare call, 1-800-MEDICARE. This information is also available on the Internet at www.medicare.gov.
Ohio KePRO the Medicare quality improvement organization for Ohio, protects the rights and health of Medicare beneficiaries. Please call KePRO Inc.'s Medicare Beneficiary Helpline at 1-800-589-7337. All of KePRO Inc.'s services are free to Medicare beneficiaries.
Medicare is the nation's largest health insurance program and covers more than 37 million Americans. Medicare provides health insurance to people age 65 and older, those who have permanent kidney failure, and certain people with disabilities.
What is "urgently needed care?" What should you do if you are in need of care and you are out of your provider's service area?
Your primary care doctor can generally provide to you urgently needed care--treatment for an unexpected, non life-threatening illness or injury that needs immediate medical attention. However, if you are temporarily out of your plan's service area and cannot wait for treatment until you return home, your health plan must pay for the urgently needed care you require.
Ohio KePRO, the Medicare quality improvement organization for Ohio, protects the rights and health of Medicare beneficiaries. Please call KePRO Inc.'s Medicare Beneficiary Helpline at 1-800-589-7337. All of KePRO Inc.'s services are free to Medicare beneficiaries.
For more information about Medicare call, 1-800-MEDICARE. This information is also available on the Internet at www.medicare.gov. 
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Fast Facts About Medicare Coverage and Benefits
Did you know that Ohio KePRO can review the care Medicare patients receive from their doctor?
Ohio KePRO's doctors and nurses can review complaints about the care a patient received in an office of any Medicare-participating doctor. Ohio KePRO performs this service free of charge, whether you are on Original Medicare or another Medicare health insurance option.
If you have a concern about a doctor's conduct, Ohio KePRO will refer your concern to the Bureau of Occupation and Professional Affairs. On the other hand, if you were given the wrong medication or have some other quality of care concern, Ohio KePRO can perform the review.
Contact Ohio KePRO to report concerns about the care you received from your doctor. We will send you a summary of complaint form. You must fill out and sign the summary of complaint form and return to Ohio KePRO Upon receiving the signed complaint form from you, Ohio KePRO will begin the review process.
Ohio KePRO protects the rights and health of Ohio's 1.8 million Medicare beneficiaries. Beneficiaries or anyone acting on a beneficiary's behalf can call our Helpline for additional information at 1-800-589-7337.
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Medicare Beneficiaries' Rights
Your right to receive quality medical care
If you feel you are receiving or have received poor quality medical care, Ohio KePRO is available to help you.
Your rights
You have the right to receive good quality medical care.Ohio KePRO is responsible for reviewing complaints about the quality of care received in or through:
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Inpatient hospitals
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Hospital outpatient departments
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Medicare HMOs
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Hospital emergency rooms
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Skilled nursing facilities
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Home health agencies
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Ambulatory surgery centers
Ohio KePRO performs this service for ALL Medicare beneficiaries, including those in HMOs or other managed care plans.
Your responsibilities
1. Call Ohio KePRO on our toll-free Helpline 1-800-589-7337.
2. Be prepared to explain your concerns.
3. Ohio KePRO will send you a form to sign to begin the review of your case.
Ohio KePRO, under a contract with the Centers for Medicare & Medicaid Services , protects the rights and health of Ohio's 1.8 million Medicare beneficiaries. Beneficiaries or anyone acting on a beneficiary's behalf can call our Helpline for additional information at 1-800-589-7337.
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