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

ComplianceCorrective 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