If a CMS surveyor showed up at your hospital tomorrow would you knów what to do? Are you sure you are in compliance with the entire grievance requirements by CMS, OCR, and the complaint standards by the Joint Commission or your accréditation organization? Do you have a grievance committee? Do you provide a written response as required by CMS? The CMS grievance requirements have recently been a frequent source of investigation. In fact, it was the third most common problematic standard for the hospital. The grievance standards are located in the patient rights section.

CMS issues their first memo summarizing noncompliance and grievances were a top problematic standard. A recent report by CMS found 928 hospitals out of compliance! Don’t let this happen to your hospital. Come learn what you need to ensure compliance. Many hospitals are surprised at the number of regulations and the detailed requirements to comply with this problematic standard.

Most every hospital in the US that accepts Medicare or Medicaid reimbursement must be in compliance with the CMS Conditions of Participation (CoPs). This program will cover in detail the CMS requirements for hospitals to help prevent the hospital from being found out of compliance with the grievance regulations.

This program will talk about a new federal law enforced by the Office of Civil Rights requirements under Section 1557 of the Affórdable Care Act. The hospital must have a grievance procedure and compliance coordinator to investigate any grievances alleging noncompliance with this law including discrimination. Thêre must be a process to promptly resolve any grievance prohibited by Section 1557.

This program will also discuss the Joint Commission standards on complaints and DNV Healthcare on grievances and how these cross walk to the CMS grievance interpretive guidelines. This is a must attend for any hospital. Staff should be aware and follow the hospital grievance and complaint policy. The policy should be approved by the board. Staff should be educated on the policy. This program will cover what is nów required to be documented in the medical record.

Objectives of the Session:

• Discuss that any hospital that receives reimbursement for Medicare patients must follow the CMS Conditions of Participation on grievances.   (This is true whether the hospital is accrêdited by Joint Commission, HCFA, CIHQ, DNV Healthcare or not). 
• Identify that the CMS regulations under grievances include the requirement to have a grievance committee,
• Discuss that the Joint Commission has compliant standards in the patient’s right (RI) chapter and DNV grievance standard in the patient rights chapter
• Recàll that in most cases the patient must be provided with a written notice that includes steps taken to investigate the grievance, the results, and the date of completion.
• Describe that the Office of Civil Rights requires hospitals to have a process to handle grievances related to discrimination under Section 1557.

Agenda of the Session:

This program will cover the followìng:

• Background on CMS CoPs
• How to find current copy
• CMS deficiency memo
• How to find changes in the hospital CoPs
• Issuance of final interpretive guidelines
• OCR grievance requirements under Section 1557
• TJC standards
• Recent standing order memo
• Preprinted order sheet changes
• Federal Register, interpretive guidelines, survey procedure
• P&P requires ensuring patients have infôrmation on rights
• Prompt resólution of grievances
• CMS Definition of grievance
• Definition of staff present
• TJC definition and six elements of perfórmance on complaints
• P&P with all the required elements
• Fórm to cóllect infórmation
• HIPAA requirements if request, not from patient
• Need to determine person is authorized, Representative
• Billing issues and infórmation on patient satisfaction
• Telephóne complaints after discharge
• Customer service and complaints
• Audits and PI required
• Policy to encourage staff
• Process for prompt resólution
• Requirement to infórm each patient on how to file grievances
• Board’s responsibility in grievance process
• Grievance committee required
• Referral to QIO and State Department of Health
• Changes to QIOs process
• P&P on grievances
• Written notice to patient requirements
• Time frame for responding to grievances
• 7-day rule
• System analysis approach
• What should critical access hospitals do?
• DNV Health NIAHO standards on grievances
• OCR Section 1557 on complaint process
  • Policy required
  • Notice to patient
  • Grievance process
  • Appeal to CEO or board
  • Time lines for filing grievance on discrimination
  • Job description for compliance person

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