The Complaint and Grievance Process
Policy
The Renal Network is contracted by the Centers for Medicare/Medicaid Services (CMS) as an End-Stage Renal Disease (ESRD) Network and authorized under the Social Security Act to receive, investigate, and when possible resolve complaints and grievances made by or on behalf of ESRD Medicare beneficiaries receiving dialysis or transplant services in Medicare certified facilities in the states of Illinois, Indiana, Kentucky, and Ohio. The Renal Network will act upon a complaint/grievance in accordance with Chapter 7 of the ESRD Organizations Manual and CMS regulations 42 CFR 405.2112 (g)
Process
When The Renal Network receives a complaint either verbally, electronically, by fax, or by letter:
- It must first determine if the problem can be handled informally through consultation, mediation or education. The Network can (with your, the complainant's permission) communicate with the facility or practitioner to help the involved parties resolve the problem and arrive at a workable solution. (Informal Complaint)
- If the problem cannot be resolved informally or if the complaint is more serious in nature then a formal grievance can be initiated to examine the issue. The formal grievance process is a longer process and involves a formal investigation and review by the Network Medical Review Board, a grievance determination,due process for the involved parties, and a final report to you, the grievant. (Formal Grievance)
- If a problem is under the jurisdiction of another regulatory agency, such as, the State Survey Agency or the Quality Improvement Organization (QIO), the Network will refer you to the most appropriate agency for review of their concern. A list of Referral Agencies (PDF, 40KB) is available and it is included in the Grievance packet. (Referral)
Facility Grievance
All ESRD patients should have information about their facility complaint/grievance process. The Network encourages you to talk to your facility staff about complaints and to use the facility grievance process as your first step. In so doing, your concern will be addressed quickly and directly and hopefully, resolved to your satisfaction and understanding.
However, if you choose not to file a grievance with your facility or you have already done so and still have concerns, you may file a complaint or a grievance with the Network. We investigate every complaint/grievance that we receive.
Network Grievance
The Renal Network's role in resolving complaints, grievances, or inquiries varies, depending upon the situation. The Network's roles include: a) Investigator, b) Facilitator, c) Advocate, d) Educator, e) Coordinator, and f) Referral Agent.
The Network has the authority to act on all complaints/grievances regarding a Medicare certified facility or made by a Medicare beneficiary alleging a facility's failure to provide care and services to which beneficiaries are entitled. The Network retuns calls regarding complaints in a timely manner and responds to written complaints within 5 days. To help us investigate your grievance, we need to know specifically what the problem is and what has been done so far to resolve it. Please use the Grievance Form to describe your grievance.
In filing a grievance, you may remain anonymous to the facility. We will not release your name to the facility without your permission. However, anonymous grievances allow the Network to make only a general investigation and documentation request that may limit our ability to look at your particular concerns. If you remain anonymous to the Network, we will be unable to share with you the outcome of the investigation. By allowing the Network to use your name, we will be able to obtain specific records as they pertain to your grievance, as well as, any additional information needed to determine the nature and extent of the problem and/or whether the services you received are within medically acceptable standards. There is a section on the Grievance Form to indicate your preference regarding the use of your name. Patients and family members have a right to address problems they identify in a facility without fear of discrimination or punishment.
If you would like a third party, such as a family member to act as your representative in the grievance process, please provide that information on the Grievance Form (PDF, 40KB) along with a witnessed, signed, and dated proxy statement. If you are a guardian filing a grievance on behalf of the patient, please submit copies of appointment documents. Information will not be shared with a third-party unless proper documentation giving such permission has been received.
Timeline
The formal grievance process at the Network involves a number of steps. You will be sent a letter within 5 business days of the Network receiving the grievance to let you know that it has been received it. The Network then has up to fifty (50) calendar days for intake, investigation/review and resolution of the grievance. Once the grievance review is completed the Network is required to advise the provider/involved practitioner of the determination and offer him/her an opportunity to comment prior to the release of the final response to the grievant (30 days). If a physician consents to have his/her name released in the grievance letter, that information is confidential and may not be re-released without the physician's consent. All steps of the grievance process will be completed within ninety (90) days plus any follow-up as needed. The Network Medical Review Board (MRB), which is an interdisciplinary group that includes patient members, reviews all grievances. When their investigation is completed, you will be sent a written report.
Trends
The Network keeps statistics on the number and kind of complaints/grievances facilities have from year to year and help facilities improve in care and relationships, when necessary.
Questions
Please call (317-257-8265 or 800-456-6919) to discuss with the Patient Services Department any questions you may have regarding the complaint and/or grievance process. The completed Grievance Form should be sent to The Renal Network, Inc., 911 E. 86th Street, Suite 202, Indianapolis, IN 46240 to the attention of the Patient Services Department.