Establishing a fair hearing policy
CMS requires that medical staffs have a policy for fair hearing and appeal. An applicant or an individual holding a medical staff appointment is entitled to request a hearing when the MEC or the board has made an unfavorable recommendation regarding staff membership or privileges.
- Unfavorable recommendations include the following:
- Denial of initial medical staff appointment
- Denial of medical staff reappointment
- Revocation of medical staff appointment
- Denial of requested initial clinical privileges
- Denial of requested additional clinical privileges
- Decrease of clinical privileges
- Suspension of clinical privileges (other than precautionary suspension)
- Imposition of mandatory concurring consultation requirement
The medical staff bylaws definition of the fair hearing process must include the following
- The process for scheduling hearings and appeals
- The process for conducting hearings and appeals
- The composition of the fair hearing panel
The fair hearing panel should not include any individual who is in direct economic competition with the affected person or who is professionally associated with or related to the affected individual. The panel may consist of medical staff members who have had no involvement in the matter and may consist of physicians not connected with the hospital in any way.
Source: Credentialing A to Z