Logan Reid
If you need to report a hospital to CMS, there are several ways to do so. CMS, also known as the Centers for Medicare & Medicaid Services, works with hospitals to publicly report hospital quality performance information on Care Compare on Medicare.gov. You can submit a complaint by calling the No Surprises Help Desk at 1-800-985-3059 or by filling out an online complaint form. If you are in Texas, you can file a complaint with the Texas Health and Human Services Commission (HHSC) by providing your name, mailing address, email, and daytime phone number. You can also submit a complaint by calling the complaint hotline or emailing HHSC INFOHFLC.
| Characteristics | Values |
|---|---|
| Reporting a hospital quality concern | Report to the Hospital Quality Alliance (HQA) |
| HQA Participants | Consumers, hospitals, providers, employers, accrediting organizations, and federal agencies |
| HQA Topics | Heart attack, heart failure, pneumonia, surgical care, outpatient imaging efficiency, emergency department, and surgical processes |
| Reporting a patient safety concern | Mail to: Office of Quality and Patient Safety, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181 |
| Reporting a complaint | Submit a complaint to the No Surprises Help Desk by calling 1-800-985-3059 or online |
| Complaint Requirements | Include supporting documentation, such as digital copies or photos of relevant documents |
| Confidentiality | HHS keeps names confidential unless required to release by law; anonymous complaints will not receive investigation results |
| Contacting CMS | Send an email to the hospital price transparency team |
| CDC and CMS Reporting | All infections meeting NHSN criteria must be reported to NHSN for incentive payments and public reporting |
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What You'll Learn
Report via the No Surprises Help Desk
To report a hospital to CMS, you can submit a complaint or question to the No Surprises Help Desk. This can be done by calling 1-800-985-3059, where you will be guided through the process of submitting your complaint. You can receive help in English, Spanish, and over 350 other languages. Before submitting your complaint, it is recommended that you gather any supporting documentation you have. This includes making digital copies or taking photos of relevant documents. When filling out the complaint form online, you will be prompted to upload these documents.
After submitting your complaint, you will receive a confirmation number. Keep a record of this number, as you will need it if you wish to check on the status of your complaint or add additional documents to your submission. You can also return to your submission and add extra documents later if necessary. If more information is required, the Help Desk will get in touch within 60 days using your preferred contact method.
The No Surprises Help Desk can review your complaint to ensure that your health insurance company, healthcare provider, or healthcare facility followed surprise billing rules. They can also investigate compliance with federal laws and policies and refer your complaint to another federal or state enforcement authority if necessary.
You can also learn about the independent dispute resolution (IDR) process and submit a billing complaint through the No Surprises Act. This includes resources for payment resolution with patients and information on out-of-network payment disputes between providers and health plans.
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Submit a written complaint to HHSC
To submit a written complaint to HHSC, you must first be based in Texas, as HHSC (Texas Health and Human Services) is an official state of Texas website.
If you have knowledge that an acute health care facility regulated by the Texas Health and Human Services Commission has provided substandard care to its patients or clients, you may file a written complaint with HHSC. Before filing a complaint, be prepared to provide the following information: your name, mailing address, email, and daytime telephone number. You may choose to remain anonymous, but if you do, HHSC will not be able to provide you with the results of the investigation.
If your complaint is regarding an abortion facility, you may not remain anonymous in accordance with Texas Administrative Code Title 26, Chapter 504, Rule 504.31(c)(2).
You can submit your complaint by mail or email. If you are emailing, send it to HHSC INFOHFLC. If you are mailing your complaint, send it to the following address: Texas Health and Human Services Commission, Mail Code 2071, P.O. Box 149347, Austin, Texas 78714-9347.
Be sure to include as much information as possible, as well as any supporting documentation you have. The more information provided, the faster the complaint can be processed.
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Report a patient safety concern to the Joint Commission
To report a patient safety concern to the Joint Commission, you can either submit your report online or through the mail.
If you wish to submit your report online, you can do so via the Joint Commission website. You will need to submit a new patient safety event or concern and provide any relevant information or documentation that supports your report. You can also submit an update or ask a question about an existing incident, but you must have your incident number to do so.
If you prefer to submit your report via mail, you can download the form for reporting a patient safety concern and send it to the following address:
Office of Quality and Patient Safety
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, Illinois 60181
It is recommended that you gather any supporting documentation before submitting your report, as this will help expedite the process. However, note that the Joint Commission cannot accept copies of medical records, photos, or billing invoices, and other related personal information.
Additionally, the Joint Commission International (JCI) has specified that it does not address billing or insurance issues, payment or financial disputes, labour disputes, case management concerns, or act on behalf of individuals. JCI also does not have the authority to weigh in on legal matters or influence hiring or termination decisions.
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Contact the hospital price transparency team
As of January 1, 2021, hospitals operating in the United States are required to provide clear and accessible pricing information online about the items and services they offer. This information is to be presented in two ways: as a comprehensive machine-readable file with all items and services, and as a display of shoppable services in a consumer-friendly format. This is to enable consumers to compare prices across hospitals and estimate the cost of care.
If you have concerns about a hospital's price transparency, you can contact the hospital price transparency team at CMS (Centers for Medicare & Medicaid Services) in the following ways:
- Submit a complaint online: You can fill out a complaint form on the CMS website. You will be prompted to upload any supporting documents. It is advisable to gather any relevant documentation before submitting your complaint.
- Call the No Surprises Help Desk: You can call 1-800-985-3059 to speak with a representative and get help with submitting your complaint. Assistance is available in English, Spanish, and over 350 other languages.
- Email: You can send an email to the hospital price transparency team at CMS. An email address is not explicitly provided, but you may receive an automated email ([email protected]) after submitting your complaint online, which you can use for further inquiries.
When submitting a complaint, it is helpful to provide as much information and documentation as possible to facilitate a prompt resolution. However, you don't need to provide every document, and you can always return to your submission to add additional documents if needed. CMS will review your complaint and may investigate the hospital's compliance with price transparency requirements.
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Report online via Care Compare
To report a hospital to CMS online via Care Compare, you can follow these steps:
Firstly, it is important to gather any supporting documentation you may have related to your complaint. This can include medical records, correspondence, or other relevant documents. Having these readily available can help expedite the complaint process. While it is not necessary to provide every single document, having as much information as possible can assist in a faster resolution. Digital copies or photographs of these documents can be made for submission.
Next, you can visit the Care Compare website on Medicare.gov to file your complaint. Here, you will find a complaint form that you can fill out. This form includes uploading any relevant documents you have gathered. Please note that for your data protection, the form resets after 15 minutes of inactivity, so be sure to submit the form once completed. After submission, you will receive a confirmation number, which should be kept for future reference.
Once you have submitted your complaint, CMS will review it along with any supporting documentation. If they require additional information, they will contact you within 60 days using your preferred method of communication. You can also call the No Surprises Help Desk to follow up on the status of your complaint and provide additional documentation if needed. This can be done by calling 1-800-985-3059 and referencing your confirmation number.
It is important to note that the hospitals displayed on Care Compare on Medicare.gov are generally limited to Acute Care Hospitals, Acute Care Veteran's Hospitals, Department of Defense Hospitals, Critical Access Hospitals, and Children's Hospitals. Only data from Medicare-certified hospitals are included on Care Compare, and most participants are short-term acute care hospitals.
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Frequently asked questions
You can submit a complaint to CMS by calling the No Surprises Help Desk at 1-800-985-3059. CMS will review your complaint and any supporting documentation you can provide.
You should provide as much information as possible to help CMS process your complaint faster. This includes any supporting documentation that you have easy access to, such as digital copies or photos of relevant documents. Your name and contact information are also required unless you choose to remain anonymous, in which case you won't receive the results of the investigation.
After submitting your complaint, you will receive a confirmation number. CMS will review your complaint and may investigate compliance with federal laws and policies. If necessary, they will refer your complaint to another federal or state enforcement authority. You can call the No Surprises Help Desk to check on the status of your complaint.
