Site Review

​​​​​​​​Contracted sites are reviewed as a condition of participation in our provider network.

A site review is conducted during the initial contracting process. The site review consists of the Facility Site Review and Medical Record Review.  In addition, a Physical Accessibility Review Survey (PARS) is also conducted at the time of the site review.


Site reviews are conducted on a variety of practice types including PCP, OB/GYN, Non-Accredited, Private Duty Nursing, Palliative Care and Substance Use Disorder providers.


Periodic site reviews will be conducted up to every three years to assure each practice site continues to meet the standards set forth by local, state, and federal regulations. A Certified Site Review nurse, using the California Department of Health Care Services (DHCS) approved review tools, conducts the review.

 

Site Review Tools

Click on the links below for the tools.

PCP/OB (Family Practice, Pediatrics, Internal Medicine)

OB Specialist Offices

Palliate Care Facilities

Wellness & Accessibility Review Survey

What is a Facility Site Review (FSR)?

A Facility Site Review is an assessment of the facility's physical site including the building, accessibility, equipment, and policies/procedures for all contracted sites at the time of initial contracting and up to every three years thereafter. This assessment is conducted by a registered nurse, who is a DHCS-certified site reviewer. The site review tool is used to determine compliance with the standards set by the DHCS.

      • Accessibility/Safety
      • Personnel
      • Office Management
      • Clinical Services
      • Preventative Services
      • Infection Control


What is a Medical Record Review (MRR)?

A MRR is a review of randomly selected medical records of members assigned to a practice site. This type of review is conducted, three to six months after an initial Facility Site Review has been completed, and is repeated up to every three years thereafter. The DHCS approved tool and guidelines are used by the Certified Site Review Nurse. The site can operate as usual during the review.

      • Format
      • Documentation
      • Continuity of Care
      • Pediatric Preventive Care
      • Adult Preventive Care
      • OB/CPSP Preventive Care (if applicable)

What is a Physical Accessibility Review Survey (PARS)?

A PARS is an assessment of how well members who are seniors or persons with disabilities can navigate a practice site. Areas evaluated during this review include the parking lot, exterior building, interior building, restrooms, and exam rooms. Sites are assigned a designation of basic or limited accessibility based on the review findings. PHC's provider directory is updated regularly for member's to see which facilities meet their accessibility needs.

What is an OB Facility Site Review (OBT)?

A Facility Site Review at an OB specialist office is similar to that of a PCP office with just a few different questions specific to this type of office. The Medical Record Review tool used is the same as that for PCP offices. OB Facility Site Reviews are conducted on a periodic basis up to every three years by a Certified Site Review Nurse.

What is a Palliative Care Facility Site Review (PAL)?

A PAL Facility Site Review is an assessment of the staff’s health care certifications, and the facility’s collaboration with the Palliative Care Quality Network (PCQN). All contracted Palliative Care sites are reviewed at the time of initial contracting and up to every three years thereafter. This assessment is conducted by a registered nurse, who is a DHCS-certified site reviewer.

What is a Palliative Care Medical Record Review (PLM)?

A PLM Medical Record Review is a review of select medical records of members assigned to a Palliative Care site. This type of review is conducted at the same time as the Palliative Care Facility Site Review and is repeated up to every three years thereafter. Areas assessed as part of this review include documented patient care plan, advance care planning, and appropriate visit documentation.

What is a Substance Use Disorder Facility Site Review (SUD)?

A SUD Facility Site Review is an assessment of the facility's physical site including accessibility, personnel, and policies/procedures for all contracted Substance Use Disorder provider sites at the time of initial contracting and every year thereafter. This assessment is conducted by a Licensed Clinical Social Worker (LCSW). The site review tool is used to determine compliance with the standards set by the DHCS.

What is a Substance Use Disorder Medical Record Review (SUM)?

A SUM Record Review is a review of randomly selected medical records of members receiving treatment at a Substance Use Disorder practice site. This type of review is conducted, three to six months after an initial Substance Use Disorder Facility Site Review has been completed, and is repeated annually thereafter. The DHCS approved tool and guidelines are used by the Licensed Clinical Social Worker (LCSW).


What is a Non-Accredited Facility Site Review (NON)?

A Non-Accredited Facility Site Review is an assessment of the facility’s physical site including the building, accessibility, equipment, and policies/procedures for all contracted sites at the time of initial contracting and up to every three years thereafter. This assessment is conducted by a registered nurse, who is a DHCS-certified site reviewer. The site review tool is used to determine compliance with the standards set by the DHCS.


W
hat is a Private Duty Nurse Facility Site Review (PDN)?

A PDN Facility Site Review is conducted to oversee the quality of care provided by a  Registered Nurses (RN) or Licensed Vocational Nurses (LVN) for in home medical services under the EPSDT Supplemental Services (SS) Program and Private Duty Case Management under APL 20-012. Areas assessed during this type of review include accessibility, personnel, clinical services, and infection control.


Facility Site Review FAQ

How long does a site review take?

Review times can vary depending on the type of review, the size of the facility, and the amount of providers being reviewed.

Do I need to close the office for the day?

No, the site can operate as usual during the review.

Does the physician(s) need to be present?

No, an office representative who is highly knowledgeable in the site's daily operations and policies/procedures is the only staff needed during the review. Some portions of the review require speaking with a clinical staff member.

Can I do anything to prepare for the review?

A letter from the nurse reviewer will be sent prior to the review outlining what you can do to prepare as well as the tools and guidelines the nurse reviewer uses during the review.

What if I don't pass?

On rare occasions, when providers don't receive a passing score, our nurse reviewers work with you to help you through the process so you are ready to see PHC members.


Medical Record Review FAQ

How long does the medical record review take?

Review times can vary depending on the amount of providers being reviewed and the size of the site. 

Do I need to close the office for the day?

No, during the review, the site can operate as usual.

Does the physician(s) need to be present?

No, an office representative that can provide access to the medical records and/or acquaint the reviewer with your EHR system is the only staff that is needed.

What can I do to prepare for the medical record review?

A letter from the nurse reviewer will be sent prior to the review outlining what you can do to prepare as well as the tools and guidelines the nurse reviewer uses during the review.

Is my participation mandatory?

As part of the contracting and credentialing process, all practice sites are obligated to participate in a medical record review.

What if I don't pass?
On rare occasions, when providers don't receive a passing score, our nurse reviewers work with you to help you through the process so you are ready to see PHC members.


Contact Us​​ For More Information

Phone: (530) 999-6828
Fax: (530) 999-6950
Email: FSR@partnershiphp.org



New 2019 PCP/OB FSR and MRR Tool Release Date TBD

Due to COVID, DHCS has postponed the release of the 2019 FSR and MRR tool and guidelines that was scheduled for July 1, 2020. The new release date will be 6 months post public health emergency. Please see below for a copy of the 2019 Facility Site Review and Medical Record Review tools and flyers on the 2019 changes.

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