CMS Regulations for Psychiatric Hospitals

The Centers for Medicare and Medicaid Services (CMS) provide guidelines and regulations for health care providers and hospitals. Psychiatric hospitals are also mandated to follow the laws and regulations according to the guidelines set forth by the CMS.

Requirements

• CMS contracts require psychiatric hospitals to provide quality care to patients and maintain ethical conditions. Psychiatric hospitals must permit CMS personnel to examine financial records upon request.

Coding

• CMS regulations mandate psychiatric hospitals to follow the appropriate insurance coding and filing requirements under the Internal Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM). In addition, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is used for diagnosis and treatment documentation.

Training

• The CMS requires special training for psychiatric hospitals regarding seclusion and restraint use on patients to ensure the safety and ethical treatment of all psychiatric patients.

Surveys

• The CMS conducts surveys on psychiatric hospitals to ensure adherence to laws and quality standards that all hospitals follow. Psychiatric hospitals must primarily have psychiatric physicians, which differ from hospitals specializing in clinical and surgical practice. In addition to monitoring psychiatric personnel, CMS surveys also monitor medications and treatments to ensure that they are geared toward psychiatric and psychological methods.

Certification

• The psychiatric hospital must be certified by the CMS and maintain its credentialing through compliance and regular site visits. Accreditation depends on maintaining psychiatric personnel, focusing on psychiatric care and strong internal processes that support documentation and appropriate diagnostic and treatment criteria. Failure to comply can result in CMS contract termination.