Accreditation Bodies for Medical Services in the US

Accreditation in American healthcare is not a formality — it is one of the primary mechanisms through which hospitals, clinics, and health systems demonstrate that their practices meet federally recognized safety and quality standards. The organizations that perform this work occupy a specific legal and regulatory position, granting facilities something far more consequential than a plaque on a wall: the ability to bill Medicare and Medicaid. This page maps the major accrediting bodies operating in the US, explains how the accreditation process functions, identifies the scenarios where it becomes most consequential, and clarifies where the boundaries between different types of accreditation fall.

Definition and scope

Accreditation in the medical context is a formal, voluntary (with important asterisks) evaluation process through which an independent organization assesses whether a healthcare facility or program meets a defined set of performance and safety standards. The word "voluntary" deserves that asterisk because, in practice, accreditation by an approved body is often a precondition for regulatory compliance and program participation under federal law.

The Centers for Medicare & Medicaid Services (CMS) is the federal anchor of this system. Under 42 CFR Part 488, CMS can grant "deeming authority" to accrediting organizations whose standards are at least equivalent to the Medicare Conditions of Participation (CoPs). A hospital accredited by a CMS-deemed organization is presumed to meet Medicare requirements — a process called "deemed status." Without it, facilities must undergo direct CMS state survey inspections instead, which is the less common path.

The major national bodies with CMS deeming authority for hospitals and health systems include:

  1. The Joint Commission (TJC) — the largest and oldest, accrediting more than 22,000 healthcare organizations and programs across the US (The Joint Commission)
  2. DNV GL – Healthcare (DNV) — uses ISO 9001 quality management principles integrated with Medicare CoPs (DNV Healthcare)
  3. Healthcare Facilities Accreditation Program (HFAP) — operated by the American Osteopathic Association, with a history stretching back to 1945 (HFAP)
  4. Center for Improvement in Healthcare Quality (CIHQ) — a smaller national body focused specifically on acute care hospitals (CIHQ)

Beyond hospitals, separate accrediting bodies cover ambulatory surgery centers, home health agencies, behavioral health programs, and laboratories. The College of American Pathologists (CAP), for instance, holds CMS deeming authority specifically for clinical laboratories under the Clinical Laboratory Improvement Amendments (CLIA), as documented by CMS's CLIA program.

How it works

The accreditation cycle follows a recognizable structure, though timelines and specific requirements vary by body and facility type.

  1. Application and self-assessment — The facility submits documentation and conducts an internal review against the accrediting body's standards manual.
  2. On-site survey — Trained surveyors — typically active or recently retired clinicians and administrators — visit the facility to observe operations, review medical records, interview staff, and trace patient care pathways.
  3. Standards scoring and findings — Surveyors score compliance against each standard. The Joint Commission, for example, uses a "Requirements for Improvement" (RFI) system where deficiencies must be corrected within defined timeframes.
  4. Accreditation decision — The body issues a decision: full accreditation, conditional accreditation (with required corrective action), or denial.
  5. Continuous monitoring — Most bodies require ongoing reporting, unannounced surveys, and periodic mid-cycle reviews. TJC began unannounced triennial surveys in 2006; DNV conducts annual surveys as part of its ISO-integrated model.

The National Committee for Quality Assurance (NCQA) operates a parallel but distinct accreditation track for health plans and managed care organizations — not facilities — evaluating performance on HEDIS measures and patient experience data.

Common scenarios

Accreditation becomes operationally visible in a handful of recurring situations that affect facilities and patients alike.

New hospital openings require accreditation before Medicare billing can begin. A facility that opens without deemed status must pass a CMS state survey, which can delay revenue by months.

Mergers and acquisitions trigger re-accreditation reviews. When a health system acquires a previously independent hospital, the acquired facility's existing accreditation status does not automatically transfer — the acquiring system must integrate it under its own accreditation framework.

Specialty program certification is a distinct layer on top of facility accreditation. A hospital accredited by TJC may separately pursue TJC's Disease-Specific Care certification for a stroke center or cardiac program. These certifications are referenced by state agencies and insurers when designating centers of excellence.

Rural and critical access hospitals (CAHs) — there are approximately 1,300 CAHs in the US (CMS Rural Health fact sheet) — face a specific decision: pursue standard hospital accreditation or rely on direct CMS state surveys, which some smaller facilities find administratively lighter.

Decision boundaries

Not all accrediting bodies are interchangeable, and the differences matter in concrete ways. Understanding the broader landscape of medical services helps clarify why facility type and payer mix drive accreditation strategy.

TJC vs. DNV is the most common comparison for acute care hospitals. TJC's standards are proprietary and detailed; DNV's ISO 9001 integration appeals to facilities already operating within quality management frameworks. Neither is objectively superior — the choice reflects organizational culture and existing quality infrastructure.

NCQA vs. URAC defines the health plan accreditation divide. NCQA focuses heavily on clinical quality measurement; URAC covers a broader range of healthcare business functions including utilization management and pharmacy benefit management.

Laboratory accreditation presents a distinct fork: CAP accreditation is widely regarded as the most rigorous and is accepted in all 50 states; the Joint Commission also offers laboratory accreditation. Facilities choosing CAP typically cite peer-inspection methodology — CAP uses laboratory professionals from other institutions as inspectors — as the differentiating factor.

A facility's accreditation status is publicly searchable through the CMS Care Compare tool, which connects accreditation data to quality ratings in a way that patients, insurers, and referring physicians can access directly.

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