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 reviews your medical records for 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:
- 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.
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.
To submit your complaint in writing, please include the following information when requesting a 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).
Complete a Care Complaint Form
Complete the following Medicare Quality of Care Complaint Form then print and mail to the above address:
Get an Appointed Representative
Any person you appoint, such as a family member, friend or your doctor, may help you:
- Request a coverage determination or an appeal
- File a quality of care concern
You must first complete the "Appoint a Representative” form (CMS Form Number 1696).
If you have questions about appointing a representative, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.