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
On initial visit, practitioners must achieve a minimum passing
score of 75%. A score of 80% must be achieved on subsequent monitoring
Site Visits Standards
- Physical Accessibility and Physical Appearance
- Handicapped parking is available.
- Handicap Access
- All offices should have handicapped accessibility. If handicapped access is not available, the physician must provide some alternative access for handicapped patients under his/her care.
- Entrance Identified
- If physician/office is in a multi-physician office/building, the physician’s name must be listed in the directory.
- Entrance clearly identified.
- Ease of entry into building and office.
- Cleanliness: Areas are free from clutter and areas appear to be cleaned regularly.
- Adequate lighting indoors and outdoors.
- Safety: Exits, corridors, rooms and entrances are free from clutter and obstruction. No cords, ripped carpets or broken flooring are observed.
- Adequacy of Waiting Room and Examining Room Space
- Waiting/reception areas neat and clean. These areas appear to be cleaned regularly and are free of excessive clutter.
- There should be an adequate number of examination rooms to accommodate patient volume. Standard: Two (2) examination/treatment rooms per MD in office per day.
- Adequate number of seats to accommodate patient volume. Standard: Three (3) chairs per physician.
- Adequacy of Medical/Treatment Record Keeping: Paper Records
- Active patient records must be easily retrieved.
- Patient records must be stored in a confidential, secure area that cannot be accessed by persons other than office personnel.
- Office staff should sign a statement, which attests to their maintaining the confidentiality of patient information.
- Patient records must be bound and organized in a standard, consistent manner.
- Record release forms available for patients.
- A current master problem list should be maintained in each file and updated as indicated by the patient’s health status.
- A current master medication list should be maintained in each file and updated as indicated by the patient’s health status.
- Adequacy of Medical/Treatment Record Keeping: Electronic Records
- Health Information and Data: Having immediate access to key information such as patient diagnosis, allergies, lab test results and medications.
- Result Management: The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results.
- Order Management: The ability to enter and store orders for prescriptions, tests and other services.
- Decision Support: Using reminders, prompts and alerts, computerized decision-support systems to help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions and facilitate diagnoses and treatments.
- Patient Safety Including Adequacy of Equipment
- All controlled substances are clearly labeled and stored in a locked area.
- Drug samples and pharmaceuticals for dispensing to patients have not expired.
- Drug samples and pharmaceuticals are stored in a secure location.
- Prescription pads are kept in an area/location away from patient access.
- Medication and food are not to be kept in the same refrigerator.
- One staff person, besides the physician, is CPR trained.
- Receptacles for medical waste are readily available and clearly marked.
- Receptacles for sharps are located in or near treatment area. (Pediatric treatment rooms should have additional precautions to prevent child access.)
- Maintenance of Equipment
- All medical equipment should be maintained according to the manufacturer’s suggested recommendations.
- Treatment area safety
- Contaminated work surfaces should be cleaned and decontaminated with a tuberculocidal disinfectant, a diluted bleach solution or an Environmental Protection Agency-registered hospital disinfectant after contact with blood or other potentially infectious materials. Meticulous cleaning and thorough rinsing must precede disinfection/sterilization.