CPMA teaches principles of medical auditing and prepares you for the CPMA certification exam.
What you will learn
- Define fraud and abuse and explain regulatory guidelines for key regulations
- Explain the impact of the OIG Work Plan and Corporate Integrity Agreements (CIAs)
- List the elements of compliance plans and identify potential compliance risk areas
- Identify National Correct Coding Initiative (NCCI) and Medically Unlikely Edit (MUE) risk areas
- Explain the HIPAA privacy rule, including details on protected health information, minimum necessary, sharing of information, and enforcement
- Identify medical record documentation standards and record retention standards
- Identify common errors found in medical documentation
- Explain the types of audits and the resources required for audits
- Define steps of the audit process and identify statistical sampling types and factors
- Explain the importance of discussing audit findings with the provider
How you will benefit
- Learn to communicate with medical professionals and assess medical documents
- Develop the skills needed to work in medical auditing
- Learn the legal standards necessary to perform well on the job
- Understand best insurance and reimbursement practices so as to relay them to patients
- This course can be taken on either a PC or Mac.
- PC: Windows XP or later.
- Mac: OS X Snow Leopard 10.6 or later.
- Browser: The latest version of Google Chrome or Mozilla Firefox are preferred. Microsoft Edge and Safari are also compatible.
- Adobe Flash Player. Click here to download the Flash Player.
- Adobe Acrobat Reader. Click here to download the Acrobat Reader.
- Software must be installed and fully operational before the course begins.
- 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
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.
- 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
- Pathology and Laboratory
- Medicine including chemotherapy, psychotherapy, physical therapy
- Diagnosis coding and medical necessity
- Physicians at Teaching Hospital (PATH) Guidelines
- 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
This is not an instructor facilitated course; however, support will be provided through email, online forms, and phone.