2016 New CMS CoP Regulations for Managing Grievances and Complaints

Event Information
Product Format
Prerecorded Event
Sue Dill Calloway, RN, MSN, JD
90 minutes
Product Description

What Hospitals Should Know about the CMS, Joint Commission and DNV Standards on Grievances?

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 and the complaint standards by the Joint Commission (TJC) 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.

CMS issues their first memo summarizing noncompliance and grievances were a top problematic standard. The January 28, 2016 report by CMS found 773 hospitals out of compliance! Don’t let this happen to your hospital.

Join Sue Dill Calloway, RN, MSN, JD, in this session to 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 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.

Sue will also discuss TJC standards on complaints and DNV Healthcare on grievances and how these cross walk to the CMS grievance interpretive guidelines. The session will also cover what is now required to be documented in the medical record. This is a must attend for any hospital since their staff should be aware and follow the hospital grievance and complaint policy, which should be approved by the board.

The AHRQ have asked the Office of Budget Management to approve a proposal to test the prototype consumer reporting system for patient safety events. This included a proposal to collect information voluntarily from patients, consumers, family members and others via the internet or telephone. This 90-minute session will discuss the AHRQ proposed consumer reporting system for patient safety events and how this could impact the area of grievances and complaints. Finally, the role of the consumer advocate in this area will be discussed.

Session Highlights:

  • Find out why any hospital that receives reimbursement for Medicare patients must follow the CMS CoPs on grievances. (This is true whether the hospital is accredited by Joint Commission, AOA, CIHQ, DNV Healthcare or not).  
  • Learn that the CMS regulations under grievances include the requirement to have a grievance committee.
  • Learn that the Joint Commission has complaint standards in the patient’s right (RI) chapter and DNV grievance standard in the patient rights chapter.
  • Know 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.
  • Insights on why AHRQ is proposing a consumer reporting system for patient safety events.

Session Agenda:

  • 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
  • TJC standards
  • Insights on recent standing order memo
  • Preprinted order sheet changes
  • Discussion on Federal Register, interpretive guidelines, survey procedure
  • Insights on P&P requires to ensure patients have information on rights
  • Learn about prompt resolution of grievances
  • What is the CMS definition of grievance
  • Definition of staff present
  • Insights on TJC definition and six elements of performance on complaints
  • P&P with all the required elements
  • Form to collect information
  • Discussion on HIPAA requirements if request not from patient
  • Need to determine person is authorized representative
  • Find out the 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
  • What is a 7 day rule
  • Discussion on system analysis approach
  • What should critical access hospitals do?
  • DNV Health NIAHO standards on grievances
  • Consumer Reporting System for Patient Safety Event
  • Proposal by AHRQ
  • Background
  • Voluntary collection of information from patients
  • Federal register proposal

Who should attend:

  • Consumer Advocates or Patient Advocate
  • Chief Operating Officer (COO)
  • All nurses with direct patient care
  • All nurse managers
  • Joint Commission Coordinator
  • All department directors
  • Chief Executive Officer (CEO)
  • Chief Nursing Officer (CNO)
  • Chief Medical Officer (CMO)
  • Chief Financial Officer (CFO)
  • Board Members
  • Quality Improvement Coordinator
  • Risk Managers
  • Legal Counsel
  • Nurse Educator
  • Patient Safety Officer
  • Emergency Department Manager
  • Nurse Managers/Supervisors
  • Compliance Officer
  • Staff Nurses
  • Clinic Managers
  • Medical Department Nurse Manager
  • Surgery Department Nurse Manager
  • OR Nurse Director
  • ICU Nurse Director
  • CCU Nurse Director
  • Outpatient Director
  • HIPAA privacy and security officer
  • Director of Business Office
  • Lab director
  • Policy and procedure committee
  • Ethicist
  • Anyone involved in the implementation of the CMS grievance or Joint Commission complaint standards

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About Our Speaker

Sue Dill Calloway - Hospital Coding Expert

Sue Dill Calloway, RN, MSN, JD, is the president of Patient Safety and Healthcare Consulting and Education company with a 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...   More Info
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