Facility Site Review Compliance Department
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
The Health Net Facility Site Review (FSR) Compliance Department is responsible for conducting facility site and medical record reviews of participating primary care physicians (PCPs), and for educating and helping providers so that they may be compliant with all regulatory agency requirements and standards of practice, including preventive care, continuity of care and health education.
The Health Net FSR Compliance Department continually develops and offers materials to simplify the documentation process. Refer to Facility Site Review to obtain materials about legal and regulatory requirements on providers' responsibilities.
Health Net's FSR Compliance nurses support and educate PCPs and their staff to meet the legal and contractual requirements for Medi-Cal members. They are designated by the Department of Health Care Services (DHCS) as certified FSR reviewers. They develop tools, forms and training packets for the providers' use in documentation of medical record criteria, preventive care services, continuity of care, health education, and other clinical interventions. On request, they offer educational material for disease management and public health programs.
The FSR Compliance nurses coordinate and conduct on-site visits for individual providers, clinics and participating physician groups (PPGs) who provide primary care services. Reasons for on-site visits include:
- Requests from providers and PPGs.
- Referral from the Health Net Quality Improvement Department following facility site and medical record audits.
- Referrals from Health Net medical directors.
- Efforts to facilitate coordination of care between primary care physicians (PCPs) and state health programs.
- DHCS contractual requirements.
- Promotion of health education programs.
- Grievance visits.
The Health Net FSR Compliance Department provides the following services and resources:
- Office system consultation and assistance with quality action plans (following facility and medical record audits).
- Individualized in-service and educational programs for providers and PPGs.
- Adult and pediatric (Medi-Cal only) medical record documentation tools - A comprehensive compilation of sample forms and tools designed to help PCPs comply with DHCS documentation requirements.
- Provider education resource packets - These packets contain copies of member handouts, references to additional resources, and sample medical management documentation tools. Topic examples available include asthma, diabetes and healthy lifestyles.
- Quick Tips for Medi-Cal managed care state health programs- Customized by county, these cards contain key concepts of many public health programs with which Medi-Cal managed care providers interact. Reference numbers and focus points assist office staff in coordinating services with these agencies.