Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Standard IX: Medical Records
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
6. Frequency of
Reviews
CC-VIII.A.3.e.5
7. Number of Medical
Records
CC-VIII.A.3.e.6
8. Medical Record
Review Strategy
CC-VIII.A.3.e.7.a-e
The health plan reviews each practice
site at least once every 3 years.
The health plan must review at least 5–
10 records at each site to determine
compliance.
The health plan submits to BMHC for
written approval and maintains a
written stragegy for conducting
medical record reviews.
The strategy includes, at a minimum:
a. Designated staff to perform the
duty.
b. The method of case selection.
c. The anticipated number of reviews
by practice site.
d. The tool that the health plan uses
to review each site.
e. How the health plan links the
information compiled during the
review to other health plan
functions (e.g., QI, credentialing,
peer review, etc.).
Yes
No
N/A
Yes
No
N/A
a. Yes
No
N/A
b. Yes
No
N/A
c. Yes
No
N/A
d. Yes
No
N/A
e. Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_IX_F2_07_11
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