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| 4/6/2020 @ 2:39:00 PM
Post 1 of 8
Contributor: Shannon Waddle, Santiam Medical Clinic
Can anyone tell me if MD/DO charts HAVE to be audited as part of your yearly review or just the non-physician provider charts?
4/6/2020 @ 2:45:00 PM
Post 2 of 8
Contributor: Charles James, North American Healthcare Management Services
The chart review should be performed on a random sample of all patient charts, regardless of payer. We recommend at least 10 charts per provider, then 10 inactive charts for the clinic. Inactive is defined as not having been to the clinic for 3+ years.
Charles A. James, Jr. President and CEO 888.968.0076 Office 314.560.0098 Cell www.northamericanhms.com This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 4/6/2020 @ 3:09:00 PM
Post 3 of 8
Contributor: Shannon Waddle, Santiam Medical Clinic
Thank you, but can you address if specifically the physician's charts need reviewed by a member of their peers or just the PA's, NP's or are you saying that the review should be random, regardless of the credential of the provider. Thanks for the clarification.
---------- Original Comments ---------- Last Post By: cjamesjr@northamericanhms.com The chart review should be performed on a random sample of all patient charts, regardless of payer. We recommend at least 10 charts per provider, then 10 inactive charts for the clinic. Inactive is defined as not having been to the clinic for 3+ years. 4/6/2020 @ 5:13:00 PM
Post 4 of 8
Contributor: Charles James, North American Healthcare Management Services
All providers' records must be reviewed.
Interpretative Guidelines ยง491.11(a) - (c) "the evaluation of practitioners must be conducted by an MD or DO; if there is only one MD or DO practicing in the RHC, it is expected that the RHC will arrange for an outside MD/DO to review the selected sample of records of RHC patients cared for by the RHC's MD/DO." Charles A. James, Jr. President and CEO 888.968.0076 Office 314.560.0098 Cell www.northamericanhms.com This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 4/6/2020 @ 5:56:00 PM
Post 5 of 8
4/7/2020 @ 4:46:00 PM
Post 6 of 8
Contributor: Briana Bales, Turjoman Pediatrics
Can you tell me where you are seeing the quote that you typed out. All I can find under 491.11(a)-(c) is it saying "The clinic conducts an evaluation, including a representative sample of both active and closed clinical records."
My MD is asking to see it and this is all I can provide him with, I cannot find what you stated which was "the evaluation of practitioners must be conducted by an MD or DO; if there is only one MD or DO practicing in the RHC, it is expected that the RHC will arrange for an outside MD/DO to review the selected sample of records of RHC patients cared for by the RHC's MD/DO." 4/7/2020 @ 4:57:00 PM
Post 7 of 8
Contributor: Charles James, North American Healthcare Management Services
Of course - This is found in the State Operations Manual Appendix G. This is CMS guidance for RHC Surveyors and how they are instructed to interpret 491.XX during surveys.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107ap_g_rhc.pdf Charles A. James, Jr. President and CEO/North American HMS 888.968.0076 Office 314.560.0098 Cell www.northamericanhms.com This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 4/8/2020 @ 10:11:00 AM
Post 8 of 8
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