Beneficiary Complaint Review

TMF conducts a number of mandatory case reviews including, but not limited to, beneficiary complaint review. Following TMF's review process, a physician reviewer evaluates beneficiary complaints to determine if the quality of care received met professionally recognized standards. When quality of care issues are identified, the physician reviewer establishes the source of the issue, the severity of the issue, and whether an improvement plan is needed. The issues are communicated to the source, such as the attending physician or provider, and an opportunity is given for exchange of information before a final decision is made. The final decision is communicated to the source, the provider (if different) and the Medicare beneficiary.