What Are CMS Regulations for Hospitals and How To Stay Compliant

Centers for Medicare & Medicaid Services (CMS) regulations for hospitals and other healthcare organizations define the federal requirements providers must follow to receive Medicare and Medicaid reimbursement. These rules govern patient safety, billing accuracy, infection control, privacy, and electronic health records (EHRs). Conditions of Participation (CoPs) refers to the specific health and safety standards organizations must maintain.

Additionally, hospitals also closely monitor regulations related to the Health Insurance Portability and Accountability Act (HIPAA), price transparency rules, and data-sharing requirements under CMS’s interoperability mandates. These represent just a small snapshot of regulations applicable to hospitals, not to mention the lightning speed at which new regulatory changes are being proposed on a regular basis.

CMS requires organizations to participate in monthly checks against the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE), General Services Administration (GSA) debarment list, and state Medicaid sanction data. Screening against other databases—like the Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), Office of Foreign Assets Control (OFAC), and Social Security death records—is optional, but often necessary. The bottom line? Skipping these checks increases exposure—and risk.

Where CMS Regulations for Hospitals Fall Short

Keeping up to date with regulatory requirements remains a complex endeavor for healthcare organizations. However, our recent Healthcare Compliance Benchmark Survey reflects a concerning gap among providers in both strategy and in systems.

The survey reveals:

• Only 22% of healthcare organizations say they actively address compliance risks identified by CMS, OIG, or the Department of Justice (DOJ).

• 13% say they’ve self-disclosed a potential violation of law or regulation to a government agency like CMS, OIG, or DOJ in the past three years.

Simply tracking new rules and CMS regulations for hospitals isn’t enough. Hospitals need to respond with speed, accuracy, and accountability.

Real-World CMS Compliance

Millennium Physician Group, one of the largest physician networks in the U.S., understands the importance of maintaining compliance across care settings. As an Accountable Care Organization (ACO), they operate under strict CMS guidelines—alongside AAAHC accreditation for surgery centers, CHAP accreditation for home care, and AMA-aligned standards for practitioners. That level of complexity demands more than manual tracking.

“We work to meet a variety of specific procedures, laws, and regulations because of the breadth of our business,” said Tina Tolliver, formerly their Chief Compliance, Ethics & Risk Officer. “Each area has different mandatory rules and policies to reflect the standards we want in place, so it’s vital to have the visibility, workflows, analytics, and processes to meet those requirements.”

By streamlining key areas like policy management, incident tracking, conflicts of interest, and audit workflows, Millennium built a compliance system that aligns with their goals—and closes out incidents in under 30 days.

It’s a reminder that CMS compliance isn’t just about meeting one set of rules. It’s also about managing overlapping frameworks across an entire care network. This way, you have systems in place that can keep up versus fall behind.

How Hospitals Can Strengthen CMS Compliance

CMS regulations for hospitals aren’t slowing down. The systems that support them can’t either.

To maintain compliance, hospitals and other healthcare organizations managing CMS regulations need an integrated solution that centralizes regulatory compliance management. This is critical to reducing risk, creating accountability, and ensuring audit-readiness.