Eligibility for Post-Review Advocacy

5065.2 – Eligibility for Post-Review Advocacy (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) A QIO should consider offering Post-Review Advocacy to a beneficiary in situations when: 1. The beneficiary conveys that he/she still has concerns about aspects of the care provided, and the QIO determines that the concerns do not relate to the clinical quality of health care itself. The concern relates to items and/or services that accompany or are incidental to the medical care; or 2. The beneficiary conveys that he/she still has concerns about aspects of the care received, but while the care is related to the clinical quality of health care received, it does not rise to the level of being a “gross and flagrant,” “substantial,” “serious or urgent,” or even a significant Quality of Care Concern. This may include situations where the QIO determines that the medical information did not contain evidence related to the beneficiary’s original complaint. The following complaints are examples of when Post-Review Advocacy is appropriate: • The beneficiary complains that the practitioner spoke to him/her in a rude manner or otherwise did not treat him/her respectfully. • The beneficiary contacts the QIO about his/her failure to receive a motorized scooter or wheelchair. • The beneficiary is concerned that he/she received a different colored pill than expected and would like the QIO to find out what drug was given.