Certified Professional Medical Auditor

WHAT SKILLS DOES A CERTIFIED PROFESSIONAL MEDICAL AUDITOR NEED?

According to the AAPC, Certified Professional Medical Auditors display skills in the following areas:

• Medical Coding Concepts
• The Medical Record
• Medical Record Auditing and Abstraction
• Medical documentation, fraud, abuse,
• Penalties for documentation and coding violations
• Scope and Statistical Sampling Methodologies
• Quality Assurance and Coding Risk Analysis
• Communication of Results and Findings

WHERE DO CERTIFIED PROFESSIONAL MEDICAL AUDITORS WORK?

Medical auditors provide an external review of records for healthcare providers. Although physicians and healthcare facilities perform audits of their own records, most CPMAs work for external reviewers such as insurance companies, major medical groups and companies, or government agencies and their contractors.

WHAT TITLES ARE ASSOCIATED WITH CERTIFIED PROFESSIONAL MEDICAL AUDITOR JOBS?

Medical audit position titles generally reflect the auditor's responsibility to examine and audit medical records in an external review. Some common titles include:

• Claims auditors
• Medicare auditors
• Medical Audit Specialist
• Recovery Audit Contractors (RACs)

Course Objectives

• 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
• 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

 ENROLL NOW

Prerequisites and Requirements:

The Certified Professional Medical Auditor course is specifically designed to help individuals with prior coding/billing knowledge prepare for the CPMA exam.

Curriculum

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.

Instructors

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

This course is open enrollment. You can enroll and begin any time.

 ENROLL NOW