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Mediation

Mediation is a form of conflict resolution that brings two or more parties together to discuss their issues with the assistance of one or more impartial third parties (the mediators). CMS incorporated mediation into the Beneficiary Complaint Response Program as an optional method to resolve beneficiaries’ quality of care complaints involving a practitioner or healthcare provider.

Benefits of Mediation

  • Mediation may reduce the risk of malpractice claims, which are expensive and time-consuming.
  • Direct dialogue with the beneficiary may result in a higher chance of a positive resolution. 
  • The relationship between the physician/provider and beneficiary may improve. 
  • Mediation provides an opportunity for both parties to determine how the complaint is resolved.

Mediation Process
All cases will go through a preliminary review by a physician reviewer before referral for possible mediation. A professional, impartial mediator facilitates discussion and assists both parties in communicating and reaching an agreement. A typical mediation session takes between two and four hours.

Cases Suitable for Mediation
OFMQ will guide the parties in a complaint as to cases that are suitable for mediation. Cases that do not exhibit clinical quality of care concerns, but that might include communications issues are the most likely. An example of a case that could be mediated: The beneficiary says he/she was given the wrong medication. The medical record indicates the medication was correct, but the instructions given were not clear or completely understood.

Voluntary Participation
Participation in mediation is voluntary. Both the beneficiary and the physician/provider must agree to participate. Either party can withdraw from the process at any time.

Confidentiality
The discussion is strictly confidential. Federal law protects the confidentiality of mediation sessions. Nothing said can be used against anyone in other legal proceedings.
Any notes taken during the mediation are destroyed at the end of the session. Mediation sessions are not recorded.