CMS Hospital Conditions of Participation Made Easy 2021 (part 4 of 5)

Time: 12:00 PM


Noon to 2 pm



IHA Members: $175 per organization
Non-IHA Members: $250 per organization

*Please note: The registration fee includes an unlimited number of connections per organization. Registrants will receive access to the program recording(s).

Offered through the Texas Hospital Association Foundation

Register Online

Back by popular demand!

A visit from the Centers for Medicare & Medicaid Services (CMS) can be stressful if you’re not prepared. A five-part webinar series designed for hospitals and health systems will cover every section of the CMS Hospital Conditions of Participation (CoP) manual, tailored to specific hospital departments. Although CMS is conducting limited surveys, prior to COVID hospitals had seen a significant increase in survey activity. Visits are especially underway following a complaint or indication of immediate jeopardy. This program will review the most problematic standards and offer tips for a gap analysis to ensure compliance—and help you prepare for your next CMS visit.

This is the fourth webinar in the five-part series.


  • Recall that CMS has patient safety requirements in the Quality Assessment Performance Improvement (QAPI) section that are considered problematic standards.

  • Describe that CMS requires many radiology policies including ones on radiology safety and ensuring all staff are qualified.

  • Discuss that a hospital can credential the dietician to order a patient’s diet if allowed by the state.

  • Review related COVID-19 reporting requirements.

Who Should Attend

This webinar series is designed for anyone involved with CoP compliance. This may include leaders and professionals in: 

  • Administration

  • Operations

  • Legal affairs

  • Clinical care: Nursing, Medicine, Pharmacy, Case Management, Rehabilitation, Infection Control and Radiology

  • Finance

  • Compliance

  • Quality improvement/Risk management

  • Facilities management

  • Board members

  • Health Information Management


Laura A. Dixon, JD, RN, CPHRM
Dixon has more than 20 years of clinical experience in acute care facilities. For the past six years she served as the Director of Facility Patient Safety and Risk Management and Operations for COPIC Companies. In this role she provided patient safety and risk management training to individuals and facilities. Dixon is a registered nurse and attorney.