Ask the expert: What do the CMS standards say about the hearing and appeal process?
Published January 2010
When it comes to the hearing and appeals process for acute and managed care facilities managing reappointment applications, the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation are silent.
CMS requires the medical staff bylaws to describe the privileging process. Thus, practitioners’ rights to a hearing and/or appeal would be contained in the described process. The national standard is to provide two levels of redress: a hearing before the medical staff and an appeal to the governing body.
This week’s question and answer are from Verify and Comply, fifth edition by Carol Cairns, CPMSM, CPCS.
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