Certified Professional Medical Auditor (Voucher Included)

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.

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

1. Compliance and Regulatory Guidelines including:
   1. Fraud and Abuse
   2. Federal False Claims Act
   3. Anti-Kickback Law
   4. Stark Law
   5. Exclusion Statute
   6. Civil Monetary Penalties Law
   7. Office of Inspector General (OIG)
   8. Centers for Medicare and Medicaid Services (CMS)
2. Medical Record Documentation Standards
   1. HIPAA Privacy Regulations
   2. Types and components of medical records
   3. Accreditation standards
3. Coding and Reimbursement Concepts
   1. CPT® Guidelines
   2. Evaluation and Management
   3. Anesthesia
   4. Surgery
   5. Radiology
   6. Pathology and Laboratory
   7. Medicine including chemotherapy, psychotherapy, physical therapy
   8. Modifiers
   9. Diagnosis coding and medical necessity
   10. Physicians at Teaching Hospital (PATH) Guidelines
4. Auditing
   1. Auditing process
   2. Statistical sampling, utilization review, RAT-STATs
5. Risk Analysis and Communication
   1. Validation of audit results
   2. Analysis and report of audit findings
   3. Communicating audit results
6. Practical Expertise
   1. Practical audit skills utilizing cases for practical application
7. Final Exam

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 12 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.

Prerequisites:

The Certified Professional Medical Auditor course is specifically designed to help individuals with prior coding/billing knowledge prepare for the CPMA exam. Certification exams offered by AAPC are only available online to candidates located in the US.

This is not an instructor facilitated course; however, support will be provided through email, online forms, and phone.

Does this course prepare you for a certification?

Yes, you will be prepared to sit for the Certified Professional Medical Auditor (CPMA®) Certification Exam offered by the American Academy of Professional Coders (AAPC). You will receive an exam voucher and AAPC membership after successful completion of the course and financial obligation.

When can I start the course?

This course is open enrollment, so you can register and start the course as soon as you are ready. Access to your course can take 24-48 business hours.

How long does it take to complete this course?

This course is self-paced and open enrollment, so you can start when you want and finish at your own pace. When you register, you'll receive six (6) months to complete the course.

What if I don't have enough time to complete my course within the time frame provided?

The time allotted for course completion has been calculated based on the number of course hours. However, if you are unable to complete the course, contact the student advising team to see what options you may have available to work out a suitable completion date. Please note that an extension fee may be charged.

What kind of support will I receive?

Our courses are designed to accommodate various learning preferences. Depending on the course structure, you may get different forms of support. Self-paced courses are designed to be user-friendly and independent, minimizing the need for external support. In courses with instructors, our direct platform support feature includes opportunities for questions, discussions, and remediation, with email and phone support available for select courses. Our student advising team is available to guide you on program requirements and administrative requests, but they do not provide assistance with course content. Our goal is to provide you with the necessary support for success, whether it's through self-paced exploration, direct communication, or guidance from our advising team.

What happens when I complete the course?

Upon successful completion of the course, you will be awarded a certificate of completion. In addition, you will receive an exam voucher for the Certified Professional Medical Auditor (CPMA®) Certification Exam, offered by the American Academy of Professional Coders (AAPC) after successful completion of the course and financial obligation.

Am I guaranteed a job?

This course will provide you with the skills you need to obtain an entry-level position in most cases. Potential students should always do research on the job market in their area before registering.

Can I get financial assistance?

This course is non-credit, so it does not qualify for federal aid, FAFSA and Pell Grant. In some states, vocational rehab or workforce development boards will pay for qualified students to take our courses. Additionally, some students may qualify for financial assistance when they enroll, if they meet certain requirements. Financing is available from select schools. Learn more about financial assistance.

How can I get more information about this course?

If you have questions that are not answered on our website, representatives are available by phone. You can also call us at 1-855-532-7642 during regular business hours to have your questions promptly answered. If you are visiting us during non-business hours, please send us a question using the "Contact Us" form.