Complaints and Grievances

What is a grievance?

A written or oral communication from an ESRD patient, and/or an individual representing an ESRD patient, and/or another party, alleging that an ESRD service received from a Medicare-certified provider did not meet the grievant’s expectations with respect to safety, civility, patient rights, and/or clinical standards of care. The grievant is not required to explicitly state that the care did not meet professionally recognized standards.

Per CMS requirements, the Network handles a patient grievance (or complaint) in one of the following three ways.

  1. Immedicate Advocacy: These are cases of a simple, generally non-quality of care nature that can be completed in 7 calendar days or less. 
  2. General Grievance: These are cases of a more complex nature that do not involve quality of care and that cannot be resolved in 7 calendar days.
  3. Clinical Quality of Care (QoC) Grievance: These are circumstances in which the grievant alleges that ESRD services recived from a Medicare-ceritifed provider did not meet the professionally recognized standards of clinical care.

For additional information about complaints and grievances, we encourage you to contact us.

 

Additional Resources

Decreasing Patient Provider Conflict  This link will take you the Provider Manual. For a print copy of the complete toolkit, please contact us

Patient Grievance Tooklit (Forum of ESRD Networks) This toolkit may be helpful for patients as they work through the grievance process.