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Accreditation: Document all complaints 

Accreditation: Document all complaints 

Tim SafleyQ. Why does my accrediting organization ask about complaints?  

A. A delivery is late, someone is unhappy with their bill, a phone call was on hold for an extended time. Each of these incidents may seem minor and yet your surveyor expects to see documentation of complaints.  

Accrediting organizations (AOs) are guided by CMS when it comes to how DME suppliers handle complaints. CMS requirements address complaints in both the supplier and the quality standards.  

CMS supplier standards specific to complaints:  

  • 13. A supplier must answer questions and respond to complaints of beneficiaries and maintain documentation of such contacts.  
  • 19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility. 
  • 20. Complaint records must include the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.  

CMS quality standards expand on these with additional detail: 

  • Notify the patient within five days that you got a complaint and are investigating it.  
  • Notify the patient of investigation results in writing within 14 days of the complaint.  
  • Keep documentation of complaints, investigations and responses to the customer.  
  • Use a performance management plan that measures consumer services, billing practices and adverse events.  

Based on the number of CMS standards related solely to complaints, it is clear why AO surveyors place a focus on how you handle complaints. 

So, document all complaints received from patients. That patient may also file a complaint with CMS (or with your AO). The documentation you have on hand will show CMS or your AO that you appropriately implemented your process for investigating and resolving complaints. 

Tim Safley is program director for DMEPOS and Sleep Accreditation with Accreditation Commission for Health Care (ACHC).


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