2019 - Grievances and Complaints: What Hospitals Should Know about the CMS, Joint Commission, DNV and OCR Standards?

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
Time lines for filing grievance on discrimination
Job description for compliance person