Post-Review Advocacy Procedures

5065.4 – Post-Review Advocacy Procedures (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) Once a QIO has obtained oral consent from all parties, the QIO may either use a conference call/three-way call or make a call on behalf of the beneficiary to resolve the beneficiary’s concerns. The focus should be on providing a quick and amicable resolution of the concerns within a short time frame—usually within eight (8) hours to two (2) business days. In some circumstances, the practitioner/provider may be unavailable for a period of time after the beneficiary consents to the use of Post-Review Advocacy. In these situations, the QIO should contact the beneficiary to explain the circumstances. The use of Post-Review Advocacy should not extend beyond ten (10) days from the beneficiary’s consent. If Post-Review Advocacy is carried out for any Beneficiary Complaint, the QIO must document its work by updating the CMS-designated case review system to describe how Post-Review Advocacy occurred and resolution of the complaint. After the Post-Review Advocacy has completed, the QIO must close the case accordingly.