This CMS standard provides:

All MAOs that offer CCPs must ensure that each contracted provider furnishing services to members maintains member health records in accordance with standards established by the MAO, which take into account professional standards.

URAC implements this standard through MAP-CCP3.

The Basics

The standard requires that your organization and sure that the participating providers in your network for their services to members using health record maintenance procedures that comply with your organization's standards, including:

• policies and procedures ensuring that your organization the network have adequate information for continuity of care and quality review; and
• policies and procedures to ensure that all members of the provider network as well as any suppliers maintain those records in accordance with your organization's standards.

URAC Accreditation Tips

kappa documents you should submit for the desktop review include policies procedures and documentation of medical record audits demonstrating compliance with the standard.  In addition, any documentation about monitoring procedures and any corrective actions your organization has used to improve providers complies with the standard would be good to submit, too.  Finally, any provider communications regarding medical record-keeping, including provider newsletters, should be submitted.

The interview of the medical Director and provider relations staff members likely will include some of the following questions:

• What is the plan's policy for member health record documentation by the provider? 
• How often do you audit the records for compliance? 
• How are the audit results shared with providers? 
• What improvement activities are expected for non-compliance? 
• Can you share with us the audit results of the last year for provider documentation of medical records? 
• How are providers informed of deficiencies? 
• What is requested of the provider when a deficiency is identified?