Overview of the Peer Review process

Rula engages in a Peer Review process to not only meet contractual requirements with payers, but also as a known clinical best practice. As fellow therapists, we understand the immense value of regularly obtaining and implementing feedback on clinical practice and documentation. 

What is peer review?

Peer Review is the process in which a trained, qualified, licensed professional evaluates the documentation practices of other therapists by way of reviewing client charts using a standardized evaluation tool.  

Which charts are reviewed and how often? 

Each month Rula selects a random sample of 411 client charts and services to review. The sample size of 411 patient charts is based on NCQA’s recommendation for sample size collection as per our Peer Review Policy. We may also select a specific provider and review several of their client charts as part of our quality monitoring processes. 

What items are reviewed during peer review?

While not exhaustive, this list provides information on the items commonly looked at during the  Peer Review process.  

Initial Assessment:

  • Was the intake assessment note template used to complete the first session?
  • Is the presenting problem clearly identified in the intake assessment? 
  • Does the intake assessment provide an overall clinical picture of the client?
  • Does the diagnosis align with the presenting problem and symptoms reported?
  • Does the treatment plan align with the presenting problem?

Progress/SOAP Notes:

  • Does the start and stop time match the CPT code requirements?
  • Was the focus of the session clear? 
  • Was the note completed within 48 hours of the service? 
  • Was the client’s response to the clinical intervention documented? 

What are the peer review results? 

Rula’s goal for each peer review item is for it to be consistently met, across the network, 90% or more of the time. When this benchmark is not met, we take a systems approach to the solution - such as looking at how we at Rula can implement quality initiatives, increase therapist support and education or even create note template changes that better support best practice and may be able to help raise the overall score. 

Below we have highlighted some areas of strength in clinical documentation found through the peer review process at Rula, and some areas of improvement. 

Areas of strength

  • The intake assessment note template is used for the first session with a client
  • Presenting problem is clearly stated in the intake assessment note template
  • A clear focus of the session is documented
  • The appropriate CPT code is noted on the progress note

Areas of improvement

  • Client response to the clinical intervention is documented
  • Progress notes demonstrate medical necessity for continued care
  • Progress note completion within 48 hours 
  • Treatment goals align with presenting problem and are measurable

If you have feedback or questions about the peer review process at Rula, please email us at quality@rula.com

 

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