Compliance with Medicare's Conditions of Participation for Hospitals
Hospitals, generally, must be Medicare certified in order to receive reimbursement for services provided to Medicare beneficiaries. This requires hospitals to be in continual compliance with federal regulations known as the Conditions of Participation (CoPs). Compliance with CoPs has always been important for Medicare-certified hospitals. The Centers for Medicare and Medicaid Services (CMS) can terminate non-compliant hospitals’ participation in the Medicare program. Although an action by CMS to terminate a hospital’s Medicare participation is an alarming experience, actual termination is very rare. CMS is required to provide hospitals with notice of the planned decertification and give them the opportunity to submit plans of correction to demonstrate continuing compliance. Most hospitals that receive termination action notices quickly come into compliance to avoid termination.
This article, published in the August issue of Compliance Today, appears here with permission from the Health Care Compliance Association. Please call 888.580.8373 with reprint requests.