Phoenix Health CompassAdvocacy Center
All complaint pathways
CMS / Medicare complaints
Medicare or Medicaid coverage, quality of care, or a participating facility is involved.
Best for
- • Medicare quality of care
- • Premature discharge
- • Coverage decisions
- • Facility conditions
Step by step
Follow these in order — skipping a step is the most common reason a complaint stalls.
- 1For quality-of-care concerns, contact your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).
- 2For coverage or claim decisions, follow the Medicare appeals levels on your Medicare Summary Notice.
- 3For nursing home or facility conditions, file with your state survey agency, which acts on CMS's behalf.
- 4Call 1-800-MEDICARE to open a case number and confirm the correct route.
What to expect
QIO quality reviews often complete within 30 days. Fast discharge appeals are decided within about 24–72 hours.
Avoid these mistakes
- Use the QIO for care quality and the appeals process for money. They are different systems.
- Note your Medicare number and claim numbers before calling.
If nothing happens
QIO → CMS regional office → HHS Office of Inspector General for suspected fraud.
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Educational purposes only
Phoenix Health Compass does not provide legal advice or medical advice. This content summarizes publicly available government and nonprofit resources and is cited throughout. Always confirm requirements, deadlines, and forms with the official agency.
Last reviewed by the Phoenix Health Compass editorial team.