CPMA Exam - Chapter 5: Corrective action Plans, Questions and answers, 100% Accurate. Approved.

CPMA Exam - Chapter 5: Corrective action Plans, Questions and answers, 100% Accurate. Approved. Except in the case of routine or annual compliance audits conducted on behalf of providers that do not have formal compliance programs or staff, - -it is not usually the auditor's responsibility to develop a corrective action plan. In the case of audits associated with voluntary repayments or disclosures under the SDP (Self Disclosure Protocol) for potentially fraudulent conduct, - -it usually falls to the entity's legal counsel to make corrective action recommendations or to develop a corrective action plan. Regardless of the circumstances, an auditor may be tasked with making - -corrective action recommendations as a critical part of the effort in developing a formal corrective action plan. To this end, it is important for an auditor to understand the basic components found in most corrective action plans Corrective Action Plans have the following components - -Review Education Development/Modification of Policies Follow-up audits Overpayment Disclosure Corrective Action Plan: Review - -Review of the audit results with the auditee and legal counsel is necessary to ensure everyone understands the basis for the conclusions expressed in the audit report This review is often performed prior to the issuance of a formal and final report. Corrective Action Plan: Review is often effective to - -identify any ambiguous or confusing portions of the report. An auditor must be a skilled writer to effectively convey the reasons behind any error. If the auditee cannot make sense of the report or understand the basis for the allegations or error, appropriate corrective action cannot occur. Corrective Action Plan: Education - -In many cases, the basis for error suggests that one or more individuals requires additional education pertaining to the particular documentation, coding or billing policies that caused the alleged error. If the MD's documentation is inadequate, education usually involves identifying specific errors or omissions. Where the cause of error is a misunderstanding on the part of the MD's coding and billing personnel, education of those individuals as to the specific policy requirements would be necessary. Sometimes the issue is more widespread, such as all members of organization involved in the performance of coding and billing of services need training. Corrective Action Plan: Development/Modification of Policies - -In some cases, an error that can be tracked to an out-of date policy, or a new, practice-wide policy is necessary to preclude future errors. (Example: a policy that requires completion of appropriate forms included in the medical chart, and the error is attributable to either the lack of any policy based instruction or a conclusion that the existing policy-based instruction is incomplete.) Corrective Action Plan: Development/Modification of Policies - -Sometimes the policy is appropriate, but the tools to implement the policy (for example, practice forms) are deficient. development or modification of existing policies, practice forms, etc., will always involve the re-training of existing staff, as well as training of all subsequent hired new staff.