Forms Compliance Correction Action Plan Instructions for completing the Compliance Corrective Action Plan

Root Cause Analysis – Step 1 Review and complete the Incomplete/Late 2728 and 2746 Root Cause Analysis Flowchart and the sample flowchart You will be required to tally the number of errors for certain fields on the 2728 and the 2746 This will assist you in identifying specific problem areas This will also determine if there is a problem with timeliness

Root Cause Analysis – Step 2 Based on the flowcharts, choose the four highest problem areas Write specific problem statements based on these areas Write specific procedures that will be implemented to correct the identified problems

Compliance Corrective Action Plan Based on step 2 of the Root Cause Analysis, complete the Compliance Corrective Action Plan template The Compliance Corrective Action Plan must be signed by the person completing the forms or Data Contact, the Administrator and the Medical Director Finally, submit the Corrective Action Plan to the Network with all required signatures