Post-Review Advocacy

5065 – Post-Review Advocacy (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) Post-Review Advocacy is an informal process that a QIO may use to resolve a continuing concern of the beneficiary after the QIO has completed the formal Peer Review process. It entails the QIO directly contacting the Practitioner and/or Provider to discuss the beneficiaries’ continuing concerns. In situations where a Beneficiary Complaint Review was completed and no significant quality of care concern was found, a QIO may voluntarily offer an additional opportunity for the beneficiary and practitioner and/or provider to resolve their dispute through Post-Review Advocacy. This alternative dispute resolution process can be used after the Peer Review process is completed, but it is not required. A QIO should summarize what Post-Review Advocacy entails for the beneficiary and obtain both the beneficiary’s and provider and/or practitioner’s oral consent to participate in Post-Review Advocacy before proceeding. A beneficiary may discontinue Post-Review Advocacy at any time during the process. See §5065.5 for additional information about discontinuing Post-Review Advocacy. Before offering the use of Post-Review Advocacy, the QIO should consider other factors that may affect the successful use of such an advocacy approach, including, but not limited to the: • Ability of involved parties to articulate their own needs and interests; • Desire for a direct, indirect, or immediate response; • Physical or mental barriers to participation by any party; • Desire for an opportunity to ask questions face-to-face or through another person; • Level of comfort in addressing conflict directly or indirectly; • Special needs of participating parties/ability of family and friends to participate in a meaningful way; • Proximity of parties and ability to meet; and • Complexity of the case (i.e., multiple settings, length of list of concerns). Post-Review Advocacy should not be used in cases where Immediate Advocacy was attempted, followed by the beneficiary ultimately filing a written complaint because an informal process has already failed.