Quality of Care

What is a quality of care concern?

A quality of care concern occurs if you have a complaint about your health care. If you feel like there was a problem with the care you received, or that you did not receive enough care, you can call Livanta to file a quality of care concern.

What are some examples of quality of care concerns?

There are a number of possible quality of care concerns. Examples include:
 - Receiving the wrong medicine
 - Developing a hospital-acquired infection that was not treated
 - Receiving incomplete or no discharge instructions
 - Not receiving care timely

How do I file a quality of care concern?

You or your representative may call Livanta to have a Medicare quality of care complaint form sent to you by mail. Or you can access the Medicare quality of care complaint form on our website. Please complete and sign the form and mail or fax it to Livanta at 1-844-420-6671.

What happens after I submit my complaint form?

Once Livanta receives the completed form, we will:

1. Contact you to be sure your concerns have been correctly identified and to explain the review process
2. Ask the providers involved with the care in question for the appropriate medical records
3. Give all the information to an independent physician reviewer hired by Livanta to review the medical records. The independent physician reviewer will decide whether accepted standards of care were met

If the physician reviewer identifies a quality of care concern, the provider or physician under review will have an opportunity to submit additional information to support the provided care. Shortly after the quality of care review is completed, Livanta will call you and the provider to present the physician reviewer’s findings. Livanta will mail a letter to you and the provider to describe the concerns you raised and Livanta’s review decision.

Can I have someone else, such as a family member or friend, speak to Livanta on my behalf?

Yes. You can appoint a representative to speak on your behalf. You can do so by using the Appointment of Representative form or by submitting a request in writing.

Following a death, can a quality of care complaint be filed on behalf of the recipient who is deceased?

Yes. The executor of the estate, spouse, or next of kin (depending on state law) can ask Livanta to review the circumstances surrounding the health care that was provided to the deceased Medicare recipient. The complaint must be filed within three years of the care in question.

Are there any fees for this service?

No. There are no fees to have your quality of care concern reviewed by Livanta.

What medical criteria is used by Livanta LLC when conducting case reviews?

Livanta LLC, as the BFCC-QIO for Areas 1 and 5, references a variety of criteria in conducting its case review work. We consider Centers for Medicare & Medicaid Services (CMS) coverage rules and regulations, and related guidance to providers and contractors. For medical necessity, we also may reference InterQual or MCG, formerly Milliman, criteria. For coding, we reference 3M coding and reimbursement resources. For quality of care determinations, we reference evidence-based care guidelines as published in the medical literature and/or compiled in decision support resources like UpToDate.

Can decisions about a quality of care complaint or discharge appeal be used in a malpractice lawsuit?

Livanta’s review findings are protected by federal rules and regulations governing confidentiality. They are not admissible for a malpractice lawsuit and cannot be released under the Freedom of Information Act (FOIA).