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Grievances and Complaints: What Hospitals Should Know About the CMS and Joint Commission, DNV Standards and OCR 120

Monday, 30 July 2018  12:15 PM PDT, 03:15 PM EDT

Training Duration = 120 min                  Sponsored by Online Compliance Panel

Click Here to register $200.00

Click Here to register and receive CD recording $400.00

If a CMS surveyor showed up at your hospital tomorrow would you know 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 accreditation 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 hospital. The grievance standards are located in the patient rights section.

A recent report by CMS found that over 1,064 hospitals are out of compliance with the hospital CoPs! 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 on what they need to do to comply with this problematic standard.

Learning Objectives:

  • Discuss that any hospital that receives reimbursement for Medicare patients must follow the CMS Conditions of Participation in grievances. (This is true whether the hospital is accredited 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 complaint standards in the patient's right (RI) chapter and DNV grievance standard in the patient rights chapter
  • Recall 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

Why Should You Attend:

Almost 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 federal law that is in effect now for hospitals and enforced by the Office of Civil Rights requirements under Section 1557 of the Affordable Care Act. The hospital must have a grievance procedure and compliance coordinator to investigate any grievances alleging noncompliance with this law including discrimination. There must be a process to promptly resolve any grievance prohibited by Section 1557. Information must also be posted on a sign in the hospital.

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 of 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 now required to be documented in the medical record.

Topics

  • 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 to ensure patients have information on rights
  • Prompt resolution of grievances
  • CMS definition of grievance
  • Definition of staff present
  • TJC definition and six elements of performance on complaints
  • P&P with all the required elements
  • Form to collect information
  • HIPAA requirements if request not from patient
  • Need to determine person is authorized representative
  • Billing issues and information on patient satisfaction
  • Telephone complaints after discharge
  • Customer service and complaints
  • Audits and PI required
  • Policy to encourage staff
  • Process for prompt resolution
  • Requirement to inform 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
    • Timelines for filing grievance on discrimination
    • Job description for compliance person

Instructor

Sue Dill Calloway is president of Patient Safety and Healthcare Consulting and Education company with focus on medical legal education especially Joint Commission and the CMS hospital CoPs regulatory compliance. She also lectures on legal, risk management and patient safety issues.

She was a director for risk management and patient safety for five years for the Doctors Company. She was the past VP of Legal Services at a community hospital in addition to being the Privacy Officer and the Compliance Officer. She was a medical malpractice defense attorney for ten years. She has 3 nursing degrees in addition to a law degree.

She is a well known lecturer and the first one in the country to be a certified professional in CMS. She also teaches the course for the CMS certification program. She has written 102 books and thousands of articles.