This online training course covers medical record standards and documentation guidelines allowing them to confidently communicate with providers. Coding and documentation compliance are key to a successful practice. This course arms the certified medical auditor with information to assist with improvements in the practice's documentation compliance. Coding and reimbursement concepts assist in a smooth work flow from scheduling the patient visit to the practice being paid for the visit. Understanding these concepts reduce overhead and reduce turnaround time for payment of services, thereby increasing the financial well-being of a practice. Medical record abstraction helps identify risk areas to a practice. Understanding what a provider documents and what will improve the provider's documentation are key to compliance.
Learning how to communicate information back to a provider improves this process. Understanding audit scope and statistical sampling methods and category risk analysis help identify where a compliance office can focus and receive the most benefit from audits. This course prepares an experienced coder to improve the financial well-being as well as the compliance of provider practices. Upon completion of this course you will be prepared for the AAPC Certified Professional Medical Auditor (CPMA®) exam. The registration fee for the exam, AAPC membership, and CPMA practice exams are included with this course.
Instructor(s):This is not an instructor facilitated course; however, support will be provided through email, online forms, and phone.
Requirements:
Hardware Requirements:
- This course can be taken on either a PC or Mac. Chromebooks are not compatible.
Software Requirements:
- PC: Windows 8 or later.
- Mac: macOS 10.6 or later.
- Browser: The latest version of Google Chrome or Mozilla Firefox are preferred. Microsoft Edge and Safari are also compatible.
- Adobe Acrobat Reader.
- Software must be installed and fully operational before the course begins.
Other:
- Email capabilities and access to a personal email account.
Instructional Material Requirements:
The instructional materials required for this course are included in enrollment. The following textbooks will be shipped to you approximately 7-10 business days after enrollment:
- Medical Auditing Training: CPMA® (PDF)
- CPT® Professional Edition
- ICD-10-CM Code Set
- HCPCS Level II
Please note: You will receive a digital book if the physical book is on backorder.
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Lesson 1
- Compliance and Regulatory Guidelines including:
- Fraud and Abuse
- Federal False Claims Act
- Anti-Kickback Law
- Stark Law
- Exclusion Statute
- Civil Monetary Penalties Law
- Office of Inspector General (OIG)
- Centers for Medicare and Medicaid Services (CMS)
- Medical Record Documentation Standards
- HIPAA Privacy Regulations
- Types and components of medical records
- Accreditation standards
- Coding and Reimbursement Concepts
- CPT® Guidelines
- Evaluation and Management
- Anesthesia
- Surgery
- Radiology
- Pathology and Laboratory
- Medicine including chemotherapy, psychotherapy, physical therapy
- Modifiers
- Diagnosis coding and medical necessity
- Physicians at Teaching Hospital (PATH) Guidelines
- Auditing
- Auditing process
- Statistical sampling, utilization review, RAT-STATs
- Risk Analysis and Communication
- Validation of audit results
- Analysis and report of audit findings
- Communicating audit results
- Practical Expertise
- Practical audit skills utilizing cases for practical application
- Final Exam
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