✅ Reviewed for accuracy and relevance by Deanna Cooper Gillingham, RN, CCM, FCM on July 22, 2025.
Accreditation is a standardized evaluation of healthcare organizations to ensure that they meet national standards for quality. The process is conducted by an external organization, in which trained peer reviewers evaluate a healthcare organization’s compliance with nationally accepted quality standards and the accrediting body’s performance standards.
Although accreditation is technically voluntary, Medicare, Medicaid, and many third-party payers often require accreditation before reimbursing for healthcare services. Accreditation is often required by local, state, or federal regulations as well.
Accreditation is regarded as one of the key benchmarks for measuring an organization’s quality. It identifies the organization as credible and reputable because the act of becoming and staying accredited promotes compliance with quality standards. Preparing for accreditation allows a healthcare organization to establish, review, and revise its standards, measure its performance, and educate its staff. It is an opportunity for the organization to identify its strengths and areas for improvement.
Accreditation signifies that a healthcare organization:
- Provides safe, effective, and high-quality care
- Follows regulatory and legal requirements
- Engages in continuous performance improvement
Accrediting bodies review:
- Organizational structure (who reports to whom)
- Policies and procedures (e.g., whether they’re up to date and up to standards)
- Quality outcomes
- Performance improvement
- Patients’ rights
- Professional improvement (e.g., opportunities within the organization, percent of employees certified in their fields)
- Leadership
- Fiscal operations
- Clinical records
- Compliance with federal, state, and local laws
Numerous accrediting bodies cover various healthcare industries, including but not limited to:
- Commission on Accreditation of Rehabilitation Facilities (CARF)
- URAC
- National Committee for Quality Assurance (NCQA)
- Joint Commission
Each accrediting body determines its standards and requirements based on its corner of the healthcare industry. But the objective is always the same: to ensure consumer protection by requiring safe, quality care. A case manager must know their organization’s accrediting body or bodies and their requirements to ensure compliance and to support accreditation efforts.
This article shares a portion of the information covered on Accreditation Standards and Requirements in CCM Certification Made Easy, 4th Edition by Deanna Cooper Gillingham, RN, CCM, FCM (2025). For more details on CMS, TJC, and NCQA accreditation, purchase your copy at CCMCertificationMadeEasy.com
