Joint Commission vs. CMS Requirements: What’s the difference?

R1 RCMMay 29, 2015

Doctor explaining medical documentation to patient

The Centers for Medicare and Medicaid Services (CMS) and The Joint Commission are bodies designed to ensure compliance with federal regulatory standards for hospitals. The goal of these programs is to ensure quality care and patient safety. By complying with the standards set by the organizations, there is greater consistency of care, better processes for patient and staff safety, and thus higher quality of care.


Given that The Joint Commission and CMS have many similarities, often times clarification is important when identifying the difference between what it means to be compliant with CMS and accredited by The Joint Commission.


So, What Exactly is the Difference?

Hospitals must meet eligibility standards established by the federal government in order to receive reimbursement from the federally funded programs, Medicare and/or Medicaid. CMS has been designated as the organization responsible for certification of hospitals, deeming them certified and meeting established standards.


The Joint Commission sets its standards and establishes elements of performance based on the CMS standards. CMS has approved The Joint Commission as having standards and a survey process that meets or exceeds the established federal requirements. The Joint Commission is one of several organizations approved by CMS to certify hospitals. If a hospital is certified by The Joint Commission, they are deemed eligible to receive Medicare and/or Medicaid reimbursement. Hospitals must be a member and pay a fee to The Joint Commission to be included in their survey process.


Therefore, a simple way to look at it is that a hospital that is accredited by The Joint Commission is by definition compliant with CMS. However, a hospital that is compliant with CMS is not necessarily accredited by The Joint Commission.

It is important to note that CMS does conduct random validation surveys of hospitals that are certified by The Joint Commission. CMS may also conduct complaint-based investigations and surveys.


Despite the fact that they are two organizations, their focus and requirements are pretty much in line with each other. Achieving accreditation status from The Joint Commission ensures your facility also meets CMS standards. Both The Joint Commission and CMS adhere to requirements that continuously aim to improve health care for the public by assuring organizations are providing safe and effective care of the highest quality and value.


Author Bio: Content written on behalf of R1 RCM.