A Practice Note explaining how hospitals and other health care entities should address unprofessional or disruptive physician behavior to comply with requirements for accreditation and Medicare Conditions of Participation. This Note describes the requirements for coverage under the Health Care Quality Improvement Act (HCQIA). It covers the HCQIA's definition of a professional review action, unprofessional or disruptive behavior, reporting requirements, and immunity from civil liability if a disciplined physician takes action against the hospital. This Note also explains the medical staff's role in drafting bylaws to establish a peer review committee and the processes required by that committee. It provides guidance for hospitals using a tiered approach to discipline where a physician has a medical or psychological condition, illness, or disability.