Facility Site Review (FSR) & Medical Record Review (MRR) Guidelines

CenCal Health conducts Facility Site Reviews (FSR) and Medical Record Reviews (MRR) for primary care providers as a requirement to participle in CenCal Health programs. Site reviews ensure that all primary care provider (PCP) sites meet the prescribed standards of the California Department of Health Care Services (DHCS)/Medi-Cal Managed Care Division (MMCD).

An Initial Facility Site Review (FSR) is part of the credentialing process.
New PCP sites must pass their Initial FSR before receiving CenCal Health member assignments.
CenCal Health conducts an initial Medical Record Review (MRR) approximately 3-6 months following the ﬁrst member assignment.
CenCal Health conducts a periodic full scope FSR and MRR every 36 months thereafter.
Every 18 months, CenCal Health performs an interim monitoring review via and attestation form or site visit.
A Physical Accessibility Review (PAR) evaluates the level of physical accessibility of the health care site. The PAR is conducted as part of every PCP FSR. It is also required as an independent review process for specialists and allied providers serving a high volume of Medi-Cal members who are part of the Seniors and Persons with Disabilities (SPD) population.

DHCS-Certiﬁed Nurse Reviewers conduct the FSR and MMR and score them with standardized DHCS guidelines and audit tools. Corrective Action Plans are required for those providers who do not meet the minimum required score.

The purpose of the reviews is to ensure that the clinic:

Provides appropriate primary health care services.
Has consistent processes that support continuity and coordination of care.
Maintains patient safety standards and practices.
Operates in compliance with applicable local, state, and federal laws and regulations.

Required Score:

A pre-contractual provider must score above 80% on the site review survey to be counted as a network provider.
Providers who score below 80% will be re-surveyed and must pass the site review survey at 80% or higher.
Providers that score 80—89% will be required to complete a Corrective Action Plan within specified timelines.

Please refer to theFacility Site Review Binderfor forms to assist your office in preparing for site visits.

DHCS has released a new All Plan Letter (APL) 20-006to reflect these updates. This APL supersedes Policy Letters (PL) 14-004, PL 03-002, and APL 03-007. DHCS recognizes the extent and impact of these changes. Providers and staff should remain informed and begin training on the updates to FSR and MRR criteria and standards.

Facility Site Review (FSR)

A Facility Site Review (FSR) is a physical assessment of a primary care practice site, including:

Accessibility/safety.
Personnel.
Office management.
Clinical services.
Preventive services.
Infection control.

The review evaluates:

Procedures/practices.
Policies.
Accessibility.
Equipment.
Infection prevention protocol.
Medical and non-medical emergency preparedness.
Operational protocols.

DHCS FSR Standards

DHCS FSR Tool

Interim monitoring guidelines

Medical Record Review (MRR)

A Medical Record Review (MRR) is an evaluation of a member’s record according to:

Format.
Documentation.
Continuity or Coordination of care.
Pediatric preventive services (if any).
Adult preventive services (if any).
Obstetric preventive care (if any).

The review evaluates criteria such as:

Availability of essential member biographical information.
Documentation practices.
Quality as evidenced by consistent and/or coordinated management of health conditions and oversight of preventive services.

DHCS Medical Record Review (MRR) Standards

DHCS MRR Tool

The following DHCS FSR Standards and FSR Tool are effective as of July 1, 2022.

FSR Tool and Guideline Update Training Video

The following DHCS MRR Standards and MRR Tool are effective as of July 1, 2022.

MRR Tool and Guideline Training Video