Resource Center
Provider Resources - Discovery Review Tools
Discovery Review Tools Revisions Feedback - July 2011
The following information describes revisions to review tools for future implementation. Please take this opportunity to offer your feedback (see instructions below) prior to implementation.
After a year of implementation, sufficient information was collected to review and revise the Administrative and Service Specific Record Review (SSRR) tools that were developed in January 2010. Changes/revisions were recommended by a number of entities including providers, individuals, Delmarva, APD and AHCA. The revisions introduce a new framework designed to ensure transparency, clarity and consistency in the review process. Each SSRR tool is divided into four sections:
- Standard
- Protocol
- Not Met Reasons
- Weights
Standards
Most of the Standards have been revised. However, the concepts being measured have not changed. Standards have been reworded and/or broken out into separate Standards for clarity. Standards were updated to accommodate changes effective in the May 2010 Handbook. New Standards have been added to the Administrative tool (#62 and #63) and to the CDC+ Representative Tool (#17, 18, 19 & 20).
Protocols
Protocols are a “quick reference” guide to help identify key requirements against which to monitor providers’ performance. The addition of protocols to our review tools helps guide a reviewer to collect information in a systematic manner to provide a clear picture of a provider’s performance and support the reviewer to make each determination. It also helps providers to understand exactly what is being referenced in each standard.
Each protocol includes:
- References for the source document(s) and page numbers where information regarding the Standard can be found.
- The key components of required documentation the reviewer will be looking for.
- Questions reviewer may ask the provider and/or the person receiving services.
- Special considerations, such as but not limited to service limitations, particular timelines or exceptions.
Not Met Reasons
The Not Met Reasons spell out the potential reasons a Standard could be scored Not Met. These were already a component of the January 2010 processes, but are now included in the Administrative and SSRR tools for providers and stakeholders to reference.
Weights
Every Standard is assigned a weight of 1, 3, 4 or 5. For more information, refer to the separate Person Centered Review (PCR) & Provider Discovery Review (PDR) Scoring Methodology [pdf].
Prior to implementation, we would like feedback from providers, individuals, family members and other stakeholders. Feedback, comments and/or questions may be submitted in writing.
To provide feedback or ask questions concerning any of the following review tools please e-mail Kristin Allen at allenk@dfmc.org and/or Theresa Skidmore at skidmot@dfmc.org (see details below...)
Delmarva Review Tools Legend [pdf]
Please include the Service name and Standard number you are referencing when submitting comments. We request any feedback be submitted no later than Monday, September 12, 2011.
If you are unable to e-mail, written feedback may be mailed to:
12906 Tampa Oaks Blvd Suite 130
Temple Terrace, FL 33637
or faxed to 813-977-0027
For questions, please call our Customer Service Representative Elizabeth Stratigeas at 1-866- 254-2075