There are two major healthcare accreditors that are nonprofit review organizations that provide accreditation to healthcare facilities and hospitals. They are the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
They both provide the majority of the information regarding HMO’s, PPO’s, private hospitals, and other various healthcare providers.
Confirming Medicare and Medicaid Providers
In the United States, the Department of Health and Human Resources Center for Medicare and Medicaid Services (CMS) gets thousands of healthcare provider requests that they will be listed as preferred providers to the people who have Medicare and/or Medicaid.
In order to do this, the CMS relies on approved Accreditation Organizations (AO) in order to come to a conclusion regarding whether a provider or agencies do meet all of the health and safety requirements of the CMS. Hospitals have to pass these inspections in order to continue receiving federal funding.
The actual healthcare providers choose which of the accreditation agencies to use based on their size and the specialty of the practice of the provider. Then there is the consideration of the fee which the AO will charge and it is in relation to the size of the business.
Accreditation for Hospital and Facilities Safety
The JCAHO is the largest provider of hospital and other facility accreditations. They also provide accreditation for physicians, supply companies, therapists, surgery centers, and laboratories.
Hospitals and healthcare facilities are not required to seek accreditation with the JCAHO. If they want to be considered as a Medicare provider and receive federal funding, they do need to be accredited by them. The hospital will either need to be accredited by them or another of the AO’s approved by the CMS.
When hospitals and other healthcare facilities meet the requirements of the CMS per the JCAHO, then they can be listed as a preferred Medicaid and Medicare provider. This then allows them to receive federal funding and other insurance companies are then open to accept them as one of their providers too.
The Importance of the Requirements and Standards
Meeting the requirements and standards of the JCAHO through the CMS means just passing all basic safety standards. If a facility cannot do this, it will be unsafe for patients and for staff. In that case, they will not be able to get funding and will not be listed as preferred providers.
This means that they will likely have to shut their doors. Don’t think that the JCAHO is all that bad though. It is because of these safety standards that patients are safer in hospitals than they would be otherwise. These are the standards that are important for health and safety of all patients.
When the Standards are Met
When the standards of one of the CMS approved accreditation Organizations are met, you know that the hospital is a safe facility. You know it has passed when it is listed as a Medicare and Medicaid provider. Basically, if it is in business it has most likely passed.