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Types of reviews and criteria
FSRs are conducted to ensure that all contracted primary care provider (PCP) sites have enough capacity to provide appropriate primary health care services and can maintain patient safety standards and practices. The FSR also confirms the PCP site operates in compliance with all local, state and federal laws and regulations.
For more information, you can check out the FSR standards and tool form.
MRRs are conducted to review medical records for format, legal protocols and documented evidence of the provision of preventive care and coordination and continuity of care services. The medical record provides legal proof that the patient received care.
You can check out the MRR standards and tool form to learn more.
The Department of Health Care Services (DHCS) requires the monitoring of PCP offices between each regularly scheduled site review audit. This review is an assessment of compliance to the critical element criteria component of the three-year full scope periodic audit. The interim FSR occurs 18 months after a periodic review takes place.
For more information, you can check out the interim FSR — 14 critical elements form.
Mandatory new standard training
The DHCS has updated the 2012 tools and guidelines effective July 1, 2022. Guidelines are now “standards” and reflect the most current multi-organization practices. The state’s managed care plans have produced two videos to comply with the required training related to the new standards. You can also download the presentation that accompanies each video.
In addition to completing the training, be sure to refer to the “improving quality of care — resource guide and obstetric updates” document for best practice and updated material.
Helpful tools and resources
You have many tools and resources to help you understand the current standards and achieve a successful review. These include:
- Sample or generic documents that you can easily customize to your needs to meet compliance
- Links to public or government entity websites that offer further guidance and information
If your office is scheduled for an initial or relocation FSR, you may request an educational visit before the official review. To learn more or schedule an appointment, contact the reviewer in your county.
Questions? You can also reach out to our Quality Management FSR team.