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Program Monitoring

Binders - Compliance and Regulations.jpg The RH Program conducts agency reviews to ensure high-quality reproductive health services are being provided and that clinical practices, policies, and processes are following certification requirements. Our intent is to both determine compliance with requirements and to provide technical assistance. In addition, reviews provide each agency an opportunity to showcase their strengths and best practices. 

Depending on the agency’s certification, reviews are conducted onsite and/or through desk audits. See below for specific schedules, tools, and materials depending on the type of certification – RHCare and CCare. (AbortionCare is coming soon)

RHCare Clinic Reviews

On-Site Reviews

The goals of on-site reviews are to: 

  • Learn more about your clinic(s).
  • Assess compliance with federal and state regulations, and RHCare Certification Requirements.
  • Identify areas where your clinic staff may need technical assistance or training.
On-site reviews are conducted over a two-day period and include observing clinic operations, interviewing selected staff, conducting chart reviews, and reviewing relevant documents. See below for the review schedule, materials, and tools.

  • RHCare On-Site Review Schedule 
  • What to Expect – Provides an overview of expectations, review methods, and two-day schedule.
  • Review Tool  - The tool used by the Nurse Consultants to determine compliance for each certification requirements.
  • Chart Audit Tool – The tool used by the Nurse Consultants to assess the scope and quality of RHCare services provided.
  • Client Experience Survey, English and Spanish – A new component to the review process to assess client-centered care and clients’ experiences. 
  • Client Survey Instructions – Instructions on when and how to administer the Client Experience Survey.
  • Final Report Template – The Final Report will be shared within 30 days of the agency review and includes all findings/results, promising practices, and recommendations.

Enrollment Form and Billing Audit Tool

Desk audits of Enrollment Forms and client visit chart notes are conducted throughout the year. Desk audits may also be initiated when indicated by monthly reviews of claims data.

CCare Clinic Reviews

CCare clinic sites are monitored regularly for accurate billing and client enrollment processes. Chart notes must support that visits' main component was contraceptive management and that the appropriate visits level was billed. Enrollment Form information is also reviewed and verified against the eligibility database.

Charting Guidance

While the RH Program uses the CVR for billing and data submission, the CVR does not substitute for charting. Clients' records must contain information sufficient to justify the diagnosis codes and medical services recorded on the CVR. This resource provides guidance of what chart notes must contain to support how the visit was billed.

Chart Documentation Guidance