Corrective Action Plans for Payer Audits and SIU

 

Expert Advice for Renegotiating with Payers and Developing Complaint Policies & Procedures

 

Once a treatment center has received notice from a Special Investigation Unit (SIU), it is necessary to determine what went wrong and how to come back into compliance with payer standards.

To do this, it’s necessary to evaluate the treatment standards and medical necessity criteria for all relevant payers, and structure a workable corrective action plan. This can include:

  • Developing new policies & procedures that comply with the standards of your payer mix.
  • Training all staff on new policies and procedures to ensure that treatment and documentation are performed as intended.
  • Negotiating with payers for past-due reimbursements.

Because all payers have unique standards, it’s important that your policies and procedures are written for your facility’s unique payer mix. For this reason, corrective action plans are extremely comprehensive. Our mission is to ensure that your facility conforms to the norms and standards set by your unique payer mix, while training your staff to follow the new policies and procedures from Day 1. This will help ensure timely reimbursements and better coordination across all levels of care.

For Joint Commission and DCF Corrective Action Plans, please see our Joint Commission Consultation page.