What Is Are Corrective Action Plans?
Corrective Action Plan (CAP) is one of the most useful tools in a healthcare lawyer’s arsenal. CAP is used to convince insurance carriers and administrative agencies that the provider will be in compliance with the rules and regulations.
Norman Spencer Law Group healthcare attorneys will draft an effective and convincing corrective actions plan for your practice!
Our Comprehensive CAP Service
Most healthcare practices can expect to be audited by federal, state, and private auditors, such as insurance carriers. The audit may find that a healthcare company is not in compliance in certain areas. It is when the auditing agencies may request or require a Correction Action Plan (CAP). CAPs can be requested by nearly every federal agency within the healthcare industry, and the plans are designed to remedy areas that are not in compliance.
Private carriers will often consider a Correction Action Plan as part of the global settlement with the healthcare provider. This can be done in lieu of disqualifying the provider from participating in the plan.
Most providers have never heard of a CAP and therefore would not be able to use it in their audit to gain the benefits it could provide. Also, attempting to create a CAP without the help of an experienced healthcare lawyer can result in an inadequate plan that does not properly address or correct the weaknesses. This can lead to an increased frequency of surveys or inspections, costly audits, administrative or regulatory action, termination from the plan, and even criminal charges.
The healthcare lawyers at Norman Spencer Law Group can help. With years of experience in the legal healthcare field, we’ve assisted many clients with strong corrective action plans designed to ensure issues are remedied and requirements met. We work with compliance officers to make sure your CAP includes the elements needed to meet regulations associated with your activities.
It’s also important to include appropriate personnel in the development of the plan to secure involvement throughout your entire company. While we work to outline and develop the plan, it’s your employees who need to follow it.
How We Develop a Corrective Action Plan
We’ve found a six-part process works well for developing a strong and effective CAP, and this process follows the acronym IERAIF:
- Root Cause Analysis
- Action Plan
- Effectiveness Checks during follow-ups
Identification: This phase pinpoints what needs to be fixed, which is typically the violation found by the federal regulators. If the DEA finds an issue with your storage of controlled substances, for instance, your CAP must address this issue to achieve compliance.
Federal regulators will not always identify the problem so directly or specifically. In such cases, it becomes necessary to inspect and compare your operations against regulations. We can then pinpoint the major areas of non-compliance. Our extensive knowledge of industry regulations allows the attorneys at Norman Spencer Law Group to be extremely helpful with this task.
Evaluation: This phase involves examining the components of the problem to determine how they impact operations. Again, if the storage of controlled substances was the issue, you want to clearly identify the consequences of non-compliant storage. What kind of impact does it have on your overall operations? This type of evaluation needs to be done for every issue on your list.
Root Cause Analysis: Identifying the root cause of the problem is the most crucial aspect of your CAP. If you’re unable to identify the root cause of the issue, there’s no way you can properly correct it. This phase is also important for showing regulators that your company understands the root cause of the problem to prevent the issue from recurring.
You may use a number of different systems for finding the root cause of a problem, such as a fishbone diagram and the Five Whys. Both of these systems can help hone in on the root cause as you’re tackling the broad issue identified during the Identification phase.
Action Plan: This phase is where you find a plan to correct the root cause and thereby solve the problem you’ve discovered. In order to be effective, it’s imperative to clearly articulate how the action plan is being carried out and implemented into your entity’s operations.
Implementation: While you’ve already touched on the implementation of the plan in the previous phase, you want to go into greater detail in this phase. Include specifics on how your CAP has been implemented. Explain how your CAP has been relayed to all employees and how employees were trained to incorporate the changes. You may also describe a test run of the plan.
Effectiveness Checks: This is the follow-up phase, which requires measuring how your CAP works to solve the problem and root cause brought to light in the earlier phases. If you created a CAP to resolve coding and billing issues, for instance, you would want to include an audit of files in this phase. This audit would be conducted to determine if codes were now being billed properly or if the issue still exists.
Effectiveness checks involve more than a one-time spot check. You need clear effectiveness checks that will be implemented over time, making them part of your overall compliance plan. In addition to internal checks conducted by employees and management, you may want to include external checks from a consultant or other professional. This shows regulators your company has an interest in and the ability to self-govern.
Creating an Effective CAP
Your CAP must clearly touch on all of the above points if it’s going to be accepted by the agency that requested it. If your CAP is rejected by the agency, or if its processes are not followed, you may face detrimental consequences. Your company may be subjected to increased audits, administrative action, or civil or even criminal culpability.
Make sure you only deal with attorneys who have extensive experience in healthcare compliance. Have them create your Corrective Action Plan! Bring on the help of an experienced attorney from Norman Spencer Law Group for the most effective results! Contact our office to schedule a consultation today.