Alternative Dispute Resolution
The Medicare Beneficiary Protection Program (BPP) is administered by the Kansas Foundation for Medical Care as the Quality Improvement Organization (QIO) for the state of Kansas. One of the functions of the Medicare BPP is to ensure that complains and concerns of Medicare beneficiaries are carefully examined to determine if clinical quality of care problems exist.
Medical record review is the process through which it is determined whether clinical quality of care problems exists. When concerns are identified, KFMC works with the healthcare providers to improve the quality of care they deliver to their patients. When significant quality of care concerns are not identified, KFMC offers the Medicare beneficiary and the healthcare providers, an option for participation in the Medicare Alternative Dispute Resolution (ADR) program.
There are 3 ADR options:
- Mediation
- Facilitated Resolution
- External Resolution
Once KFMC has determined whether a case is suitable for ADR, we will start the ADR process by contacting the Medicare beneficiary to offer ADR as an option. Mediation and Facilitated Resolution are cooperative, voluntary and confidential processes, with the goal of reaching a resolution, or agreement, based on the interests of all involved parties. Please reference the above links for details of these options.
External Resolution occurs when, in the course of pursing the mediation or facilitated resolution ADR options, the healthcare provider contacts the Medicare beneficiary, or the beneficiary contacts the healthcare provider, to discuss what might be done to resolve the complaint. The external resolution process addresses the issues outside of the QIO (KFMC) involvement.