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Program Monitoring

State RH Program staff review providers to ensure the provision of quality services andBinders - Compliance and Regulations.jpg
accurate enrollment and billing practices. On-site reviews of RH Program agencies are
conducted according to a three-year review schedule and include desk audits. Separate
desk audits of both RH Program and CCare-only agencies are conducted more frequently
and as needed. 

For more information on the different types of reviews, see: Agency Review Types

For a schedule of all the types of review see: Review Schedule

The rest of the documents on this page are the tools state staff use to perform these on-site reviews and desk audits. Agencies may use them to prepare for an on-site review or for internal quality assurance / quality improvement practices. 

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

RH Program Review Tools

On-Site Reviews

On-site reviews are conducted to ensure that high-quality reproductive health services are being provided and that enrollment and billing practices follow program regulations. The reviews include observing clinical practices and conducting medical records review (i.e. chart audits). 

RH Program On-Site Review Schedule

RH Program Chart Audit Tool

RH Program On-Site Review Tool 

RH Program On-Site Review Tool Guidance

Enrollment Form and Billing Audit Tool

Desk audits of RH Program 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.

Reviews of CCare-only Clinics

CCare-only 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.

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