IPRO contracts with the federal government to evaluate and improve care provided to people on Medicare and to ensure their rights. Quality Improvement Organizations like IPRO, as part of their contract, offer a Beneficiary Complaint Response Program to help Medicare beneficiaries and their families get the most out of their Medicare benefits and to understand and partner in the care they receive. Beneficiaries who have a concern, or who are not satisfied with the care they receive, can file a complaint or inquiry with IPRO by calling 1-800-331-7767.
Medical record review is the usual process used for handling beneficiary complaints. The purpose of the review is to determine whether standard guidelines or expected practices were followed by the health care provider in the particular complaint being reviewed.Another approach to resolving beneficiary complaints is through a process called mediation. Mediation may be offered if the case meets certain guidelines as determined by an IPRO physician.