Chapter 2: Healthcare Compliance Program Fundamentals

Standards-Setting Organizations

Healthcare accreditation and certification programs can help organizations foster compliance with regulations and requirements, and to further quality improvement, risk management, and safety initiatives. Participation in some accreditation programs may serve as proof of compliance with regulatory requirements. For example, several accreditation programs are deemed by Medicare to evidence compliance with Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoP) required for reimbursement. Additionally, accreditation may be a condition for reimbursement by some health plans and government payer programs. Accreditation may also help provide consistency and standardization across organizational processes, as requirements for accreditation require application of a regimented set of standards for participation.

Many organizations in the healthcare industry offer accreditation and certification programs, and specialize in certain sectors of the healthcare industry. Here is a selection of reputable and widely recognized accreditation programs that cover a variety of healthcare sectors.

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