Ask the expert: What do the CMS standards say about the hearing and appeal process?
Credentialing Resource Center Connection, January 14, 2010
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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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