QUESTION: I find some aspects of the Medicare system complex and confusing. And sometimes I don't agree with the quality or appropriateness of the care I have received or been denied through Medicare delivery. What is in place for Kansas residents to channel their concerns and disagreements concerning Medicare?

ANSWER: Fortunately, an organization in Kansas focuses on Medicare review and patient rights. The federal government has a designated "peer review organization" (PRO) to provide independent medical review and monitoring of Medicare services. The PRO in Kansas is the Kansas Foundation for Medical Care, which helps to ensure that Medicare patients receive medical care that is necessary, appropriate, and of high quality.

It is the foundation's job to ensure that Kansas Medicare beneficiaries are aware of their rights. The foundation also works with hospitals, physician offices, nursing homes, home health agencies, hospices, and other health care providers in Kansas to monitor the quality of health care for older adults.

If you are hospitalized, the Kansas Foundation for Medical Care encourages you to make sure the hospital gives you a brochure titled "An Important Message from Medicare" when you are admitted. The brochure describes your rights and responsibilities and tells how to contact the foundation.

Good-quality medical care includes the right to make choices about the treatment you receive as a Medicare patient. The foundation encourages you to talk to your doctor first about your medical treatment, your need for hospitalization, or your discharge date. You and your doctor know more about your health needs than anyone else.

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

• All hospital care necessary for the proper diagnosis and treatment of your illness or injury. Discharge is determined by medical needs, not by what Medicare pays.
  
• Be fully informed about decisions affecting your Medicare coverage or payment for your hospital stay.
  
• Appeal any written notices you receive from certain health care settings stating that Medicare will no longer pay for your care. Just call 800-432-0407, Option 1.
  
• Have the foundation review your written complaints concerning quality of care received in a Medicare-certified hospital, skilled nursing facility, home health agency, ambulatory surgery center, or hospital outpatient area (including the emergency room) by calling 800-432-0407, Option 2.
  
• File an appeal if you believe you are being discharged too soon from a Medicare facility.
  
• File a quality-of-care complaint.

Help is only a phone call away
The Kansas Foundation for Medical Care offers a toll-free information line for all Kansas Medicare beneficiaries and their family members. The purposes of the information line are to answer questions about beneficiary rights and responsibilities, gather information regarding complaints, and provide appropriate contact information to other Kansas agencies.

The organization also stresses the importance of taking advantage of preventive care such as getting annual mammograms and keeping influenza and pneumonia vaccinations up to date. The toll-free number, 800-432-0407, operates Monday through Friday, 8:00 a.m. to 4:30 p.m.

For additional information about the foundation, visit www.kfmc.org.