Treatment Record Review
The intent of the treatment record review (TRR) process is to ensure treatment and service records are current, detailed, and organized. TRRs are completed to monitor adherence to record standards and to improve the overall quality of clinical treatment.
TRR tools are based on applicable HealthChoices regulations governing each level of care, PerformCare policies and procedures, the PerformCare provider manual, current mental health or substance abuse initiatives promoted by Pennsylvania, and best practices recognized for mental health and substance use services by PerformCare physician advisors. These indicators include the adequacy of documentation in:
- Continuity and coordination of care.
- Crisis planning and relapse prevention planning.
- Discharge planning.
- Intake assessment and referrals.
- Progress notes.
- Quality indicators, such as use of evidence-based practices, assessment tools, and outcome monitoring.
- Recovery orientation.
- Treatment and service plans.
The TRR process is coordinated with the PerformCare credentialing cycle. This means that providers will receive an on-site or desk review when a provider is due to be recredentialed with PerformCare. This process allows for more fully informed credentialing decisions. TRR results are presented to the credentialing committee for review and provide updated information regarding the quality of clinical treatment and other information that may have been obtained through a review of the record sample.
The performance goal for network providers to meet is a minimum benchmark of 80 percent for the total review score.
PerformCare also has a performance goal range that designates when the next review will occur and if additional actions are required following a TRR:
- 90 percent – 100 percent — above standard documentation. Very limited opportunities noted for improvement, with the minimum benchmark considerably exceeded. The provider will be reviewed in accordance with triennial recredentialing cycle. High achievement will be noted in results letter and during presentation at credentialing meeting. Recognition will be noted in other PerformCare documentation regarding the provider.
- 80 percent – 89 percent — standard documentation. Minimal opportunities for improvement noted, with the minimum network-wide benchmark of 80 percent achieved. No Quality Improvement Plan (QIP) required. Provider will continue to be reviewed in accordance with recredentialing cycle.
- 70 percent – 79 percent — below standard documentation. Moderate number of opportunities for improvement noted. QIP is required. Review occurs annually until score is increased to 80 percent or above.
- 69 percent and below — well below standard documentation. Significant number of opportunities for improvement noted. QIP is required, and a subsequent review will occur in six months and annually until score is increased to 80 percent or above.
Providers who score below the benchmark performance goal of 80 percent are required to submit QIPs within 30 days of the date they receive the results letter. For a QIP to be considered completed, the QIP must:
- Contain an action step for each indicator listed as an opportunity.
- Delineate the staff person who will assume responsibility for implementation and completion of the QIP.
- Contain a start date and planned completion date.
- Clearly indicate evidence of completion (e.g., measureable objectives for each action item).
PerformCare will continue to meet individually with providers to review tools, at the provider's request, and will also collect any feedback that providers may have during exit interviews. If you are a provider interested in meeting individually to review the TRR tools, please contact your assigned account executive.