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ed2go Health and Fitness Medical Certified Professional Medical Auditor
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certified-professional-medical-auditor

Certified Professional Medical Auditor

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 in improvements for documentation compliance within the practice. 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.

6 Months / 80 Course Hrs
Open enrollment

Offered in Partnership with your Preferred School

Central Michigan University

Why this school? It's been chosen based on your location or if you've visited this school's website. Change School

Learning Method

Instructor-led

Self-Paced. Study on your own schedule

Contact Us for additional information

Certified Professional Medical Auditor

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Details + Objectives

Course Code: GES166

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 documentation for evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, and medicine services
  • 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 the course is taught
  • Self-paced, online course
  • 6 months to complete
  • 6 months to complete
  • 80 course hours
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

Outline

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Compliance and Regulatory Guidelines

Learn about fraud and abuse, federal false claims acts, anti-kickback laws, stark laws, exclusion statutes, civil monetary penalties law, and more.

Medical Record Documentation Standards

Study HIPAA privacy regulations, types and components of medical records, and accreditation standards.

Coding and Reimbursement Concepts

Evaluate and manage code and reimbursement concepts regarding anesthesia, surgery, radiology, pathology, and more.

Auditing

Explore the auditing process, and study statistical sampling, utilization review, and RAT-STATs.

Risk Analysis and Communication

Learn about the validation of audit results, audit findings, and how to communicate audit results.

Practical Expertise

Develop practical audit skills used to utilize cases for practical application.

Details
  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
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Instructors & Support

No instructor

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

Requirements

Prerequisites / Requirements

Prerequisites:

There are no prerequisites to take this course. However, knowledge of medical terminology and anatomy (or AAPC courses)  is strongly recommended.

Requirements:

Hardware Requirements: 

  • This course can be taken on either a PC or Mac.

Software Requirements: 

  • 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.
  • Email capabilities and access to a personal email account.
  • Software must be installed and fully operational before the course begins.
Instructional Materials

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 (current year)
  • ICD-10-CM Code Set (current year)
  • HCPCS Level II (current year)

About Certification

american-academy-of-professional-coders-aapc

The American Academy of Professional Coders (AAPC) is one of the world’s most recognized institutions for professional medical coders, with more than 175,000 members. The AAPC offers more than 30 certifications that include medical billing and coding, compliance, and management, among other topics. These certifications are an excellent way to prove you have a working knowledge of specific aspects of healthcare, and the skills you need to practice in the field. All AAPC certifications share a common goal: help everyone from beginners to experienced professionals advance their careers and contribute positively to the industry.

FAQs

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Can I register for a course if I am an international student?

Yes, ed2go courses are online, so you never have to actually travel to the school. Most schools offer telephone or online registration.

Does this course prepare 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 your Student Advisor to help you work out a suitable completion date. Please note that an extension fee may be charged.

What kind of support will I receive?

You may be assigned with an instructor or team of industry experts for one-on-one course interaction. Your support will be available (via e-mail) to answer any questions you may have and to provide feedback on your performance. All of our instructors are successful working professionals in the fields in which they teach. You will be assigned to an Advisor for academic support.

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?

ed2go courses are non-credit, so they do 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: https://www.ed2go.com/career/financial-assistance

How can I get more information about this course?

If you have questions that are not answered on our website, please feel free to contact us via LIVE CHAT or by calling us at (855) 520-6806. If you are visiting us during non-business hours, please feel free to send us a question using the Contact Us form.

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