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The due process manual, Part 9: Appeals and reporting
The Health Care Quality Improvement Act of 1986 (HCQIA) has no provision or requirement for an appellate review mechanism. However, if your hospital is accredited by The Joint Commission (TJC), standard MS.10.01.01, EP 5 states, “With the governing body, provides a mechanism to appeal adverse decisions as provided in the medical staff bylaws.” Since TJC accredits approximately 88% of U.S. hospitals, it’s worth our time to outline an appeal process that makes use of best practices. Even though TJC requires an appeal mechanism, the particulars of the process are left up to each medical staff.
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