Medicare - Credentialing & Recredentialing
Site Visits (Practitioners only)
ConnectiCare may conduct site visits for complaints related to physical accessibility, physical appearance, and adequacy of waiting room and examining room space. The site visit includes, but is not limited to, an assessment of the physical accessibility and appearance, the adequacy of waiting room and examining room space, adequacy of equipment, and patient safety practices.
On initial visit, practitioners must achieve a minimum passing score of 75%. A score of 80% must be achieved on subsequent monitoring visits.
Standards for Performing Site Visits
A. Access to Facility
a. Handicapped parking is available.
b. Parking should be off-street.
2. Handicap Access
a. All offices should have handicapped accessibility. If handicapped access is not available, the physician must provide some alternative access for handicapped patients to his/her care (i.e., a statement of policy that the physician will perform house calls for handicapped patients or will provide services at an alternate accessible site at no extra cost to patient/payer).
b. Patient bathroom can accommodate handicapped patients.
3. Entrance Identified
a. The building and/or office is easily identified.
b. If physician/office is in a multi-physician office/building, the physician’s name must be listed in the directory.
B. Waiting/Reception/Treatment Areas
1. Waiting/reception areas neat and clean. These areas appear to be cleaned regularly and are free of excessive clutter.
2. There should be an adequate number of examination rooms to accommodate patient volume (Standard: two  examination/treatment rooms per MD in office per day.)
3. Discussion that includes protected health information should not be audible from the waiting room or other patient areas.
C. Safety Practices*
a. All refrigerated medications must be in a separate refrigerator. They must not be stored in the same refrigerator as beverages and foodstuffs.*
b. All controlled substances are clearly labeled and stored in a locked area.*
c. Drug samples and pharmaceuticals for dispensing to patients have not expired.
d. Drug samples and pharmaceuticals are stored in a secure location.*
e. Prescription pads are kept in an area/location away from patient access.*
a. There is a plan to handle emergencies both natural and medical. A written plan is preferred.*
b. One staff person, besides the physician, is trained in CPR.
* Items designated with an asterisk are considered key elements. Any facility with noted deficiencies in one of these categories is required to submit a Corrective Action Plan. Two or more deficiencies will necessitate a Corrective Action Plan and a revisit in six months to assess improvement.
a. Receptacles for medical waste are readily available and clearly marked.*
b. Receptacles for sharps are located in or near treatment area. (Pediatric treatment rooms should have additional precautions to prevent child access.)*
a. There is evidence of proper sterilization (autoclave, disposables, liquid sterilant).*
b. If by autoclave, equipment is tested regularly. A maintenance record should be maintained.*
5. Treatment area safety
a. Examination room(s) are cleaned and prepared for each patient and med- ical supplies used for prior patients have been removed.
b. Contaminated work surfaces should be cleaned and decontaminated with a tuberculocidal disinfectant or a diluted bleach solution after contact with blood or other potentially infectious materials. Disinfection/sterilization must be preceded by meticulous cleaning and thorough rinsing.*
D. Contractual Review
1. Office staff is cooperative when scheduling site visit and medical review.
2. Office staff and physician are courteous and respectful.