Which of the following actions is critical when conducting a claim review under a CIA?

Ensuring full compliance with regulations is critical when conducting a claim review under a Corporate Integrity Agreement (CIA). A CIA typically arises from compliance issues or investigations where the government and the provider agree on specific guidelines to prevent future violations. The primary goal of these agreements is to enhance the compliance program of the organization, which includes adhering to all relevant laws, regulations, and internal policies.

In the context of a claim review, maintaining compliance involves thoroughly evaluating claims against regulatory standards to confirm their accuracy and appropriateness. This rigorous process helps organizations avoid potential legal consequences and mitigates risks of future compliance issues. It also reflects a commitment to ethical practices and accountability, which is essential for building trust with stakeholders and regulatory bodies.

Moreover, full compliance ensures that the organization not only rectifies past issues but also establishes a framework for ongoing adherence to compliance requirements—this is particularly important under the terms of a CIA that may involve monitoring and reporting obligations. Therefore, focusing on compliance as part of the review process emphasizes the importance of regulatory adherence and supports the long-term integrity of healthcare operations.