Ensuring the highest standards of patient care and safety is paramount in the healthcare industry. For Primary Care Physician (PCP) sites participating in the Medi-Cal Managed Care Program in California, this commitment is upheld through mandatoryFacility Site Reviews (FSRs) and related assessments. These reviews are mandated by the California Code of Regulations (22 CCR § 56230) and California Department of Health Care Services (DHCS) All Plan Letter 22-017, outlining specific requirements for provider sites. Anthem Blue Cross (Anthem) actively supports its network providers in navigating these crucial evaluations through its comprehensive Clinical Site of Care Review Program.
Key Components of the Review Program
The Anthem Clinical Site of Care Review Program is designed to assist PCP sites in meeting the rigorous standards set forth by California regulations. This program primarily revolves around three core components:
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Facility Site and Medical Record Review (FSR/MRR): The Full Scope Review (FSR) is a thorough evaluation to confirm that contracted PCP sites possess the necessary resources and infrastructure to deliver appropriate primary healthcare services while maintaining stringent patient safety protocols. This review ensures operational compliance with all pertinent local, state, and federal laws and regulations. Complementing the FSR, the Medical Record Review (MRR) focuses on the meticulous examination of medical records. This examination verifies adherence to format standards, legal protocols, and the documented provision of preventive care, along with seamless coordination and continuity of care services. Medical records serve as critical legal evidence of the care provided to patients.
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Physical Accessibility Review Survey (PARS): To ensure inclusivity and accessibility for all patients, particularly seniors and persons with disabilities, the Physical Accessibility Review Survey (PARS) is conducted. This survey assesses the physical adequacy of provider sites, ensuring they meet the specific needs of these populations.
Resources Provided by Anthem
Recognizing the complexity of these review processes, Anthem Blue Cross has developed an extensive library of resources to support providers. This collection is categorized under FSR, MRR, and PARS sections, aiming to empower providers to:
- Deliver safe and effective primary care services.
- Guarantee and reinforce the quality of care provided.
- Maintain thorough and accurate documentation of clinical services.
- Ultimately, improve overall health outcomes for members.
Anthem’s resource library includes a diverse range of materials. Many resources are developed in-house by Anthem, providing tailored guidance. Additionally, the library incorporates sample documents and best practice resources from reputable external sources, which providers can adapt to their specific operational needs. Furthermore, Anthem’s program provides direct links to relevant public and governmental websites, offering access to additional guidance and valuable resources beyond Anthem’s own materials.
By leveraging Anthem’s Clinical Site of Care Review Program and its comprehensive resources, PCP sites can confidently navigate the requirements of FSR, MRR, and PARS, ultimately contributing to enhanced patient care and regulatory compliance.
