Beneficiary complaints about healthcare have historically been resolved through a formal medical record review.  This review can often take 3-6 months to complete and detailed information about the outcome of the review may or may not be shared with the beneficiary or their representative.

The Centers for Medicare & Medicaid Services (CMS) introduced mediation as a program component in 2003 to offer the beneficiary an opportunity to engage in direct dialogue with a provider regarding a complaint. Participation in the mediation program is voluntary and confidential. Mediation may help resolve beneficiary complaints more quickly and with less cost and less risk of litigation. 

The mediation process is a no-fee service that provides an opportunity for a provider and beneficiary to work through their issues with an impartial mediator who facilitates communication. Mediation allows both parties to tell their story and share their perceptions and/or educate each other on how the healthcare experience was perceived.  

A professional mediator assists both parties in reaching a mutual agreement. The complainant and provider agree to meet face to face (although telephonic mediation can occur). Mediation usually takes a few hours for both parties to reach an understanding. Their agreement is put in writing, and when necessary, monitored by CIMRO of Nebraska.

Mediation is suitable for cases that do not have a quality of care concern exhibited.  A CIMRO of Nebraska physician reviewer will determine whether or not a case is appropriate for mediation.