Conditions of Participation are the Federal Standards that Health Care Organizations are required to be in compliance with , in order to receive Medicare and Medicaid certification and payment . There are specific CMS CoPs related to Privileging :
Condition of Participation : Governing Body
1 . Standard : Medical staff . The governing body must :
• Ensure the criteria for selection are individual character , competence , training , experience , and judgment ; and
• Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification , fellowship , or membership in a specialty body or society .
Condition of Participation : Medical Staff
2 . Standard : Medical staff bylaws . The medical staff must :
• Include criteria for determining the privileges to be granted to individual providers and a procedure for applying the criteria to individuals requesting privileges .
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