Medical Record and Facility Site Reviews

HPSM conducts Site Reviews to ensure that all primary care provider (PCP) sites are in compliance of the standards of the California Department of Health Care Services (DHCS)/Managed Care Quality and Monitoring Division (MCQMD).

All participating PCP sites must undergo initial site review upon contracting with HPSM, and at least every three years thereafter per DHCS guidelines and as part of the re-credentialing process, regardless of the status of other accreditation and/or certifications. New PCP sites must pass their initial FSR before receiving HPSM member assignments, and an initial MRR is conducted approximately 3-6 months following the first member assignment.

Site Reviews are conducted to ensure PCP sites :

  • Provide appropriate primary health care services
  • Has processes in plan that support the coordination and continuity of care
  • Maintains safety standards and practices
  • Operates in compliance with local, state, and federal laws and regulations

There are three components of the Site Review Process:

  1. Facility Site Review (FSR)
    • Physical assessment of PCP site including six areas: Access/Safety, Personnel, Office Management, Clinical Services, Preventative Services, Infection Control
  2. Medical Record Review (MRR)
    • Evaluation of a member’s medical record according to six areas: Format, Documentation, Continuity/Coordination of Care; Pediatric Preventative Services, Adult Preventative Services, Obstetric Preventative Services
  3. Physical Accessibility Review (PAR)
    • Physical accessibility evaluation of sites that provide care to members including Seniors and Persons with Disabilities (SPDs). Sites include: PCP sites, community-based adult service sites, high-volume specialist sites, other ancillary sites as appropriate. Onsite evaluation includes areas: Parking, Exterior Building, Interior Building, Restroom, Exam Room, Exam Table/Scale.

Facility Site Review Tool and Standards

A Facility Site Review is a physical assessment of procedures/practices, policies, accessibility, equipment, infection prevention protocol, medical and non-medical emergency preparedness, and some operational protocol.