Grievances and Complaints: Complying with the CMS CoPs, Joint Commission, DNV Standards and OCR

Product Id : HE126
Instructor : Sue Dill Calloway
May 20, 2019 1:00 PM ET | 12:00 PM CT | 10:00 AM PT | 90 Minutes

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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? A recent report by CMS found that over many hospitals are out of compliance with these hospital CoPs.

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. The best practice is for hospitals and their staff to listen to patients when they have complaints and grievances and try to resolve them. Best practices also looks to evaluate the complaints and determine if changes should be made to the system to ensure patient safety and improved outcomes.

There is obviously a big practice gap between what hospitals are doing and what they are supposed to do. Grievances are the second most problematic standards for hospitals. In the latest CMS deficiency report there were 1,700 hospitals out of compliance. This number more than tripled from just six months prior. Part of the problem is that the hospitals do not like what they are required to do. The hospitals are supposed to inform the patient in writing what they did and when they did it.

This program by expert speaker Sue Dill Calloway, RN, MSN, JD, will cover in detail the CMS requirements for hospitals to help prevent the hospital from being found out of compliance with the grievances and complaints regulations.

Session Highlights:

  • Overview and background of CMS Conditions of Participation on grievances
  • CMS’ regulations that requires hospitals to have a grievance committee
  • Joint Commission’s complaint standards in the patient’s right (RI) chapter and DNV grievance standard in the patient rights chapter
  • Providing a written notice to patients
  • OCR’s requirement for hospitals to have a process to handle grievances related to discrimination under Section 1557
  • Final interpretive guidelines
  • How to find the current copy of the regulations
  • Going through the CMS deficiency memo
  • How to find changes in the Hospital CoPs
  • CMS definition of grievance
  • TJC definition and six elements of performance on complaints
  • Form to collect information
  • HIPAA requirements if request not from patient
  • Billing issues and information on patient satisfaction
  • Telephone complaints after discharge
  • Customer service and complaints
  • Process for prompt resolution
  • Board’s responsibility in grievance process
  • Changes to QIOs process
  • 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

Who Will Benefit:

  • Consumer Advocates or Patient Advocate
  • Chief Operating Officer (COO)
  • All nurses in direct patient care
  • Joint commission coordinator
  • Department directors
  • Quality improvement coordinators
  • Risk managers
  • Legal counsel
  • Nurse educator
  • Patient safety officer
  • Emergency department manager
  • Compliance officers
  • HIPAA privacy and security officer
  • Anyone involved in the implementation of the CMS grievance, DNV, OCR, or Joint Commission complaint standards    
Speaker Profile:

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 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.

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