CoP Spotlight: Quarterly Clinical Reviews

Many smaller agencies sometimes find it difficult to focus on performing clinical reviews.  But the Medicare Conditions of Participation (CoPs) actually require your agency to do so.

 

In agencies that are large enough to have a quality assurance (QA) department, QA staff perform quarterly chart reviews with the assistance of clinical staff from each discipline that the agency is certified to provide.  While conducting a review, the CoPs require that it be documented, and that it evaluate the effectiveness of the clinical programs of the agency, all in accordance with Medicare guidelines.  Quarterly reviews must also document and determine if care was provided in accordance with the plan of care and if the outcomes of the care provided were appropriate.

 

The use of outcomes in benchmarking your agency against peers is routinely being done now with the implementation of Home Health Care and, coming this summer, the addition of Star Ratings.  As the summer closes in, we will be providing more information on how Star Reviews will either help push your agency forward or be detrimental to your agency’s success.

 

To review the full text and applicable standards to apply to your own QA program, please review the following CMS regulation:

 

  • 484.52(b) Standard: Clinical Record Review, Appendix B – Guidance to Surveyors: Home Health Agencies

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf [Page 79]

 

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