Medicare Information

The Medicare program wants quality and effective care for people who have Medicare. To help make this happen, the Centers for Medicare & Medicaid Services (CMS) works with one organization in every state to serve as the Quality Improvement Organization (QIO). As the QIO for Minnesota, Stratis Health does two basic jobs:

1. Protects the rights of people with Medicare.
   1. Medicare rights and responsibilities
   2. Concerns and complaints
2. Supports doctors and other health care providers in delivering health care that is medically necessary, appropriate to patient needs, and follows professionally recognized standards of care. We work with doctors, hospitals, nursing homes, home health agencies, and managed care plans to ensure that the care given meets clinical standards and guidelines.

Rights and Responsibilities Under Medicare

Medicare consumers have the following rights and responsibilities under the Medicare program.

Rights of People with Medicare

As a person with Medicare, you have the right to:

• Medical care that meets professionally recognized standards of quality
• Medical care for as long as it is medically necessary
• Complete information and answers to your questions about Medicare coverage and decisions regarding your care
• A written plan that states what services you will need following medical care you receive

Responsibilities of People with Medicare

For the Medicare program to be effective in maintaining good overall health for people and to be cost effective for the American public, people with Medicare have the following responsibilities:

• Take advantage of the "Welcome to Medicare" exam covered under Part B
• Exercise, eat right, avoid smoking
• Get regular check-ups and screenings
• Get a flu shot every year
• Get a mammogram every year or as directed by physician
• Keep a record of vaccinations and screening tests, and know when they are due
• Take medications as directed by your doctor, and know when and why you take them

Concerns and Complaints

Stratis Health can assist Medicare consumers and their families (representatives) with:

• Appeals related to discharge or denial of coverage
• If a health care provider decides that the services you are receiving will no longer be covered by Medicare, and you disagree with that decision, you can request an immediate, independent review of that decision. Stratis Health does those reviews for Medicare consumers in Minnesota.
• Concerns about your clinical quality of care
• Discuss the quality of clinical care you received. We can help you understand your options for resolving disputes with your health care provider about your medical treatment concerns.
• File a formal quality of care complaint. We can work with you to file a complaint about the quality of care you received in a hospital, emergency department, nursing home, rehabilitation center, physician office, home health agency, or by another Medicare provider.
• Other assistance with other Medicare issues (such as billing, coverage) and other health care issues