2016 New CMS CoP Regulations for Managing Grievances and Complaints: What Hospitals Should Know about the CMS and Joint Commission and DNV Standards

Duration: 90 Minutes
Most of the hospitals in the US that accept 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.
CMS Grievance Interpretive Guidelines
Instructor: Sue Dill Calloway
Product ID: 501592
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 now required to be documented in the medical record.

Objectives of the Presentation
  • Discusses 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 accredited by Joint Commission, AOA, CIHQ, DNV Healthcare or not).
  • Identifies that the CMS regulations under grievances includes the requirement to have a grievance committee
  • Discusses that the Joint Commission has complaint standards in the patient's right (RI) chapter and DNV grievance standard in the patient rights chapter
  • Recalls 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.
Why Should you Attend
If a CMS surveyor shows 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 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. 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.

Areas Covered
This program will cover the following areas:
  • 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
  • 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
Who can Benefit
  • 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
Note: Critical Access Hospitals (CAH) have a separate set of hospital CoPs and there is no corresponding restraint standard and the only mention of restraints is in the swing bed section. However, CAH are expected to have some system of grievance and complaint resolution. Therefore, many CAH adopt most of the requirements. This program will be helpful in determining suggested practices for policy implementation. CAH hospitals that are in systems should know the differences in the two sets of CoPs and may find the program of interest for that reason.
$300
Recorded Session for one participant
Get life time access with download option!
Book this course
Pay Now
  $450.00 Training CD
Free shipment within 4 Working Days of placing the order. Get life time access for unlimited participants.
  $550.00 Training USB Flash Drive
Free shipment within 4 Working Days of placing the order. Get life time access for unlimited participants.
For multiple location please contact our customer care team +1-510-857-5896.
How it works
Live Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • The webinar joining link, username and password for joining the webinar will be updated on your OCP Account 24 hours prior to the webinar
  • Presentation handouts in Downloadable PDF format will be updated on your OCP Account 24 hours prior to the live session
  • Login to the audio conference on the scheduled date and time
  • Get answers to your queries through interactive Q&A sessions via chat at the end of the session
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account 24 hours after the completion of the session
  • Please let us know your thoughts and views at the end of the webinar, your valuable feedback will help us improve
Recorded Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • Upon purchase of the recorded session a link will be updated on your OCP Account within 24 hours
  • Please click on the link to access the Recorded Session
  • Presentation handouts in downloadable PDF format will be updated on your OCP Account within 24 hours of the purchase of the product
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account after 48 hours of the product Purchase
  • Please share your valuable Feedback at the end of the session
Instructor Profile:
Sue 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.
View More