File a Quality of Care Complaint: 1-800-725-8315

TMF Health Quality Institute is the Quality Improvement Organization (QIO) for people with Medicare in Texas. Each state in the country has a QIO working to protect Medicare patient rights and improve the quality of health care in each state. TMF provides review of your medical records to review any quality of care issues and conducts statewide health projects to improve your health and quality of life.

TMF wants to ensure that every doctor, facility, and agency provides Medicare patients with high quality medical care. TMF can review your concerns regarding care provided by your doctor or a facility such as the following:

Hospital
Rehabilitation facility
Ambulatory surgery center
Skilled nursing facility
Home health agency
Hospice agency

TMF reviewers evaluate medical records of Medicare patients and review them to determine if the services meet professionally recognized standards of health care, are medically necessary, and are delivered in the most appropriate setting.

Examples of quality of care concerns include:

Medication errors
Unnecessary or inappropriate surgery
Unnecessary or inappropriate treatment
Change in condition that was not treated/misdiagnosis
Discharged from the hospital too soon
Incomplete discharge instructions and/or arrangements

If you feel you have not received quality health care from a provider of Medicare services such as those mentioned above, you may ask TMF to do a review of the medical record.

Telephone Complaints

To request a Quality of Care review, please call TMF’s beneficiary complaint helpline at 1-800-725-8315 or contact 1-800-MEDICARE (1-800-633-4227) and ask for the Quality Improvement Organization to file a complaint.

Written Complaints

To submit your complaint in writing, please include the following information when requesting TMF review of a Medicare patient’s medical records:

Medicare patient’s name and Medicare number
Medicare patient’s complete address and phone number
Type of services rendered
Name and address (including city) of the facility where care was given
Date(s) care was received
Description of the quality of care concern
If you are enrolled in an Medicare Advantage Organization, please include the organization’s name and address

Mail your letter requesting review to:

TMF Health Quality Institute

Review and Compliance

Bridgepoint I, Suite 300

5918 West Courtyard Drive

Austin, TX 78730-5036

If you have general questions about Medicare coverage, billing or claims, or how to enroll in Medicare, please call 1-800-MEDICARE (1-800-633-4227).

Alternative Dispute Resolution

TMF Health Quality Institute offers Alternative Dispute Resolution (ADR) as an option to resolve Medicare beneficiary complaints about the medical care they receive under the Medicare program. If the complaint does not involve quality of care issues, voluntary and confidential ADR services may be offered. When you call TMF to file a complaint, a review case manager will give you more details. If your complaint is suited for ADR, the process will be further explained to you. Click here for more information.