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 People with Medicare

 File a Quality of Care Complaint or Appeal

Please Read: Important Announcement About Medicare Reviews Starting August 1, 2014

KEPRO is now the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for Wisconsin, assuming responsibility for all QIO case reviews on behalf of Medicare beneficiaries in our state.

KEPRO Toll-free Beneficiary Helpline: (855) 408-8557

Call 1-800-MEDICARE if:

  • You have complaints about care provided outside of Wisconsin
  • You have general questions about Medicare coverage
  • You need clarification on how to enroll in Medicare
  • You wish to discuss billing issues
  • You want to learn more about Medicare benefits and services

You can also visit www.medicare.gov External Link - New Window for general information on Medicare.

About Appealing an Impending Discharge or Service Termination

Act Quickly
Medicare beneficiaries receiving care within the state of Wisconsin have the right to appeal their hospital discharge or other Medicare covered skilled services ending.

Hospital Discharge Appeal
If you have been notified that your inpatient hospital care is about to end, and you believe that you still need these services, it is important to begin the appeal process quickly. The appeals process does not apply to care that is provided while under “observation” in a hospital. Be sure to ask your hospital case manager whether the care you are currently receiving is under “inpatient” or “observation” status. The hospital is required to give a Medicare beneficiary inpatient a Medicare notice titled “An Important Message from Medicare” which explains the appeal rights.

Medicare Covered Skilled Services
If you have been notified that Medicare covered medical services such as rehabilitation, nursing home, home health, or hospice care is about to end (termination of services), and you believe that you still need these services, it is important to begin the appeal process quickly.  The provider is required to give the Medicare beneficiary a Medicare notice titled “Notice of Medicare Non-coverage” which explains the appeal rights.

How to Initiate an Appeal
Any Medicare beneficiary or authorized representative (for example, family member, legal guardian, or caregiver) can request an appeal. Please be sure to share this information with your family.


  
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