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Contracted services can be a huge risk to hospitals if they are not managed under scrutiny. That is why CMS and TJC require hospitals to have a process to evaluate contracted services. The evaluation needs to ensure compliance with the provisions contained in the contract regulations and standards with oversight from the hospital board. Whether the hospital uses its own employees or contractors, the hospital is liable for evaluating contracted services to ensure patients receive quality care.
This program will cover contract requirements for hospitals accredited by TJC, the CMS hospital CoPs for contracts, TJC’s contract tracer, CMS and TJC telemedicine standards, and the standards for hospitals accredited by DNV GL.
The Joint Commission Standard LD.04.03.09
|- Contracts with other accredited organizations||- Telemedicine contracts||- Performance improvement requirements|
|- Nature & scope of services||- Monitoring contract performances||- Contract lab services|
|- Safety & quality requirements||- Consults & referrals||- Contract standards & EPs|
|- Credentialing & privileging||- CMS changes on telemedicine||- TJC's contract tracer|
|- Issued transmittals||- Hospital leadership's responsibilities||- Communicating expectations|
CMS Contract Regulations & Interpretive Requirements
|- Introduction to the CoPs||- Deficiency memos||- List of required contract services|
|- Board responsibilities||- Identifying quality problems||- Contract requirements|
DMV-GL Standards on Contract Management
|- Measurement, monitoring & analysis||- Legal responsibilities||- Telemedicine contracts|
|- Contract service requirements||- Safe & effective contracts||- Contract requirements|
Anyone involved with or interested in contract management, including but not limited to: CEOs, CFOs, COOs, CMOs, CNOs, CE Directors, Department Directors, Quality Improvement Staff, Nurses (all levels), Compliance Officers, CMS Liaisons, TJC Liaisons, Registration Staff, Safety Officers and Staff, Pharmacy Staff, Ethics Committee Members, Consumer Advocates, Risk Managers, Legal Counsel, Case Managers, Hospice Staff and Regulatory Affairs Staff.