CMS Interpretive Guidelines for Complaint/Grievances

The hospital must establish a process for prompt resolution of patient grievances and must inform each patient whom to contact to file a grievance.

Change in bedding, housekeeping of a room, and serving preferred food and beverages requires a written response.

CoP stands for Conditions of Patients

If a verbal patient care complaint cannot be resolved at the time of the complaint by staff present, is postponed for later resolution, is referred to other staff for later resolution, requires investigation, and/or requires further actions for resolution, then the complaint is a grievance.

The hospital’s governing body must review and resolve grievances, unless it delegates this responsibility in writing to a grievance committee.

Quality Improvement Organizations (QIO) are hospital employees charged with reviewing the appropriateness and quality of care rendered to Medicare beneficiaries in the hospital setting.

Grievances about situations that endanger the patient, such as neglect or abuse, should be reviewed immediately, given the seriousness of the allegations and the potential for harm to the patient(s).

Select ALL of the CMS interpretive guidelines for complaint/grievances:

A grievance is considered resolved when the hospital is satisfied with the actions taken on the patient's behalf.

Medicare patients have the right to appeal a premature discharge