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The Joint Commission & CMS Rules Require Communications with Providers in Care Delivery Settings

By Taylor Ryan | October 8, 2015

Note: This is the first of a two part series on the importance of provider communications in today’s healthcare delivery environment.

The Joint Commission (TJC) and CMS have established specific rules on provider communications. If it is discovered during an audit that a hospital has not been following these rules, it can be fined or shut down. There are several rules and they are very detailed. Following is a summary of what they entail.

The rulings are divided into Provision of Care (PC) and Elements of Performance (EP). The PC rulings deal mainly with coordination of care communications when a patient is discharged or transferred. The hospital is required to give information about the care, treatment, and services provided to the patient to other service providers who will provide the patient with care, treatment, or services.

The EP rulings deal mainly with the hospital's communication process for handing-off patients and about how hospitals should inform other service providers who will provide care, treatment, and services to the patient about the list of community resources or referrals made or provided to the patient. The hospital must have a process to receive or share patient information when the patient is referred to other internal or external providers of care, treatment, and services.

CMS has its own rules and conditions for participation:

  • The patient has the right to have a family member or representative of his or her choice and his or her own physician notified promptly of his or her admission to the hospital.

  • The hospital must transfer or refer patients, along with necessary medical information, to appropriate facilities, agencies, or outpatient services, as needed, for follow-up or ancillary care.

The bottom line is that all of these TJC and CMS regulations require detailed communications between multiple physicians working in a variety of care delivery settings. If you do not have a Unified Provider Management (UPM) Platform, that provides access to a national network of verified provider profiles that can be customized and integrated into your hospital’s provider base, you are working at a significant disadvantage.

A UPM will allow you to manage your provider (referring and credentialed physicians, nurses, and mid-levels) profiles across all of your core IT clinical, financial and operational systems. In addition, it can provide access to a national physician/provider database that will allow you to identify and communicate with physicians across town or across the country, facilitating compliance with all of the foregoing TJC and CMS regulations. This single, accurate, source for provider information can streamline your workflow, enhance care coordination, significantly improve productivity, and can even optimize your revenue cycle.

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