Certified Medical Compliance Officer (CMCO)®

Earn the premier compliance certification for medical office professionals. CMCOs are highly trained compliance professionals who understand the role, responsibilities, and tactical skills needed to control risk and lead practice compliance efforts.

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Compliance management in a medical office grows more complex each year. It is no longer a question of "if" you will be audited, but "when." Regulatory agencies such as the Office of the Inspector General (OIG) and audit contractors may at any time request to review your compliance plan, billing and documentation for services rendered, paper and electronic storage of patient records, business agreements, and so on. Your office must have someone on staff that understands current rules and knows how to protect the practice from compliance problems that can draw hefty fines and penalties if an auditor uncovers overpayments or alleged fraud.

The CMCO is created for non-hospital healthcare professionals. Experience working in a medical office is recommended for this course. The material presented in the CMCO program provides candidates with advanced knowledge that very few practice management professionals have attained. This specialized training guides the development, implementation, and management of a complete compliance program and serves as an ideal platform for professional growth.

Compliance expertise is among the most valuable and versatile attributes in healthcare. CMCOs are proficient in the development, implementation, and management of an ongoing compliance program. They have advanced compliance knowledge that few medical office professionals have obtained.

A compliance program extends beyond the mere maintenance of paper or electronic records. It represents an ongoing effort to operate a medical practice or clinic in an ethical manner within the four corners of the law. A well-designed compliance program can benefit a physician’s practice by speeding up and optimizing the proper payment of claims, minimizing billing mistakes and may reduce the likelihood of an audit.

The average cost of a data breach for a healthcare organization in 2016 was $402 per individual record. Multiply that figure by the number of electronic records in your system — penalties can add up quickly. Having a Certified Medical Compliance Officer on staff will help minimize costly threats to your organization. CMCOs are proficient in the development, implementation, and management of an ongoing compliance program. They have advanced compliance knowledge that few medical office professionals have obtained.

Lack of knowledge won’t hold up in a federal audit. Medicare and Medicaid have expanded audit contractor programs tasked with identifying fraud, waste, and abuse. UPICs, ZPICs, RACs, and other contractors are authorized by CMS to come into your office and request the documentation that supports the claims for reimbursement that you have submitted to the Medicare program. These onsite audits can occur with little or no notice. Remember, even honest mistakes can trigger an audit.

A cookie-cutter plan won’t do. A template downloaded from the Internet won’t meet federal compliance expectations. The CMCO program provides all the resources your office needs to develop and maintain a custom program that fits your unique requirements. Learn to evaluate and update policies and procedures, implement training, and much more.

The CMCO program provides candidates with tools and tactical skills needed to assist your office in meeting regulatory obligations and minimizing threats to the organization. Equally important, if you are audited, the training provides proof that your organization has taken steps to comply with applicable billing and coding rules.

Don’t be intimidated. This is scary stuff, but we know this subject inside and out. PMI has spent more than 30 years teaching medical office professionals how to do it the right way. This program was carefully developed by leading compliance experts, Robert W. Liles and D.K. Everitt. The curriculum is taught with the medical office professional in mind with real-world compliance examples relevant to your office. You’ll learn to handle tough situations with ease.

The CMCO curriculum covers everything your office needs to know to stay compliant with federal guidelines. Robert Liles and D.K. Everitt are experts who are intimately involved in the business of healthcare compliance and management. The material covered in this program represents a tremendous amount of information and real-world experience, systematically presented during each class meeting. 

Compliance structure and enforcements

  • The seven elements of the compliance plan
  • Health care fraud enforcement and sentencing guidelines
  • False Claims Act, Stark, and the Federal Anti-Kickback Statute
  • Calculation of civil monetary penalties
  • Whistleblower complaints
  • Legal provisions of compliance with a review of actual case examples
  • Impact of Health Care Reform on enforcement statutes and practices
  • Performing a gap analysis and other means of identifying practice-specific risks Billing/coding/coverage and reimbursement

 

Billing/coding/coverage and reimbursement

  • Coding, billing and documentation considerations
  • LCDs/NCDs and their applicability to coverage decisions
  • Drafting and incorporating the office compliance plan
  • Mission statement, codes of conduct, and organizational goals
  • The growing threat of electronic security and identity theft Compliance, risks, actions and issues

 

Compliance, risks, actions, and issues

  • Role of the Compliance Officer in the organizational hierarchy
  • UPICs, ZPICs, RACs, SMERCs, and other Medicare/Medicaid contractors
  • Correct handling of an audit request
  • Organizational risks, peer review actions, state licensure issues
  • Employee screening, staff, and patient relations
  • Employee notification of obligations and consequences for failure to comply
  • Drafting enforcement and discipline provisions
  • Ongoing monitoring and auditing
  • Overview of law enforcement organizations Medicare exclusion and its impact on an organization

 

Medicare exclusion and its impact on an organization

  • Permissive vs. mandatory exclusion
  • Co-payments, waivers, deductibles, and write-offs
  • Overpayments, federal Anti-Kickback, False Claims Act, and Stark implications
  • Gratuities, kickbacks, and payments to physicians
  • Types of referrals that may violate one or more federal statutes
  • Business relationships between your practice/clinic and other providers
  • Setting up mechanisms for employees to file anonymous complaints
  • Avoiding allegations of reprisal and responding to identified deficiencies
  • Voluntary repayments - advantages and disadvantages of making repayment Law enforcement investigation tools

 

Law enforcement investigation tools

  • Subpoenas and search warrants and how to respond to compulsory process
  • Employment of consultants, lawyers, and other third-party advisors
  • Federal and non-federal administrative appeals of denied claims
  • HIPAA/HITECH and the relationship between privacy and compliance
  • Business associate pitfalls to consider
  • Future risks to your organization

 

Five hours are allotted for the certification exam and a score of 70% or better is required to earn the CMCO certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.

Live Class

Attend instructor-led classroom sessions, hosted in select hospitals, healthcare organizations, medical societies and colleges across the U.S.

 

Live Certified Medical Compliance Officer classroom format includes a full course manual and timed, five-hour proctored certification exam. A score of 70% or better is required to earn the CMCO certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.

Live Webinar

Participate in the Certified Medical Compliance Officer course remotely with access to a series of twelve live 90-minute instructor-led webinar sessions (limited availability). Live session attendance is not required; registered webinar participants can access the recordings online anytime 24-48 hours after the original recording date.

 

This format also includes a full course manual and timed, five-hour proctored certification exam scheduled by PMI’s Exam Coordinator in a testing center near the candidate’s location. A score of 70% or better is required to earn the CMCO certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.

Online Training

Start the Certified Medical Compliance Officer online training program anytime with access to twelve pre-recorded 90-minute instructor-led sessions.

 

The Certified Medical Compliance Officer on demand format includes a full course manual and timed, five-hour proctored certification exam scheduled by PMI’s Exam Coordinator in a testing center near the candidate’s location. A score of 70% or better is required to earn the CMCO certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.

Request Exam

Exam challenge is not available for the CMCO certification. 

The CMCO is created for non-hospital compliance professionals to authenticate compliance expertise and provide a pathway for further growth in this important area of expertise. It is the first curriculum created specifically for compliance professionals in small physician practices, home health agencies, hospices, and DME companies. It is also well suited for consultants and those working in community mental health clinics, third-party billing companies, and other non-hospital healthcare environments.

Development Team

Robert W. Liles, JD, MBA, MS, was the first National Health Care Fraud Coordinator and subsequently worked as Deputy Director of the U.S. Department of Justice, Executive Office for United States Attorneys. As Managing Member in the Washington D.C. based office of Liles Parker, PLLC, Robert heads one of the nation’s leading law firms focused on health care fraud defense and regulatory matters representing providers in civil, criminal, and administrative proceedings. Robert’s background, education, and experience bring this class to life with a real-world perspective.

D.K. Everitt, CMCO, CCO, is a nationally-known Health Care Compliance Officer whose work includes assessing hundreds of medical facilities, implementing Corporate Integrity Agreements and OSHA compliance training. He has authored several compliance books and serves as President of The Compliance Division, L.L.C. He has spent the last 25 years developing and managing corporate compliance programs and shares his talents as an Adjunct Lecturer and Preceptor for Trinity University’s Health Care Administration Graduate Studies department.

Robert and D.K. are seasoned experts in the business of healthcare compliance and management. The material covered in this program represents a tremendous amount of information and real-world experience, systematically presented during each class meeting. 

The best defense is a proactive approach. Your compliance plan serves as evidence of a good faith effort to comply with applicable laws and regulations. Should the government ultimately choose to pursue criminal charges against you or your organization, your demonstrated use of an effective Compliance Plan will be favorably credited under the points system set out under the Federal Sentencing guidelines. 

    - Robert W. Liles, JD, MBA, MS

Hear what others have to say

“As physicians, we are just not prepared to deal with all of the laws and regulations that the Office of the Inspector General (OIG) expects us to be compliant with. The Certified Medical Compliance Officer class teaches you how to prepare your practice for an audit by the OIG. Physicians, especially, need to be aware that each practice is responsible for the wrongful acts of its employees, and that failure to know applicable laws and statutory provisions, such as the False Claims Act, Anti-Kickback Statute, Stark Laws and Fraud and False Statements, is not a defense and can lead to large monetary. Attending this class will benefit physicians who run their own practice, or who are interested in any aspect of legal compliance.” 

- Steven F. Crawford, M.D.; Chair, Committee on Scientific Activities; MedChi, The Maryland State Medical Society

 

I wanted to take a moment and say how very much I appreciate the privilege to take the CMCO course.  Wow!  What a fantastic course!  Robert and DK were both exceptional speakers!  This course is perfect for the physician's office for compliance.  The materials were well written and provided excellent explanations for the reader.  I know I will refer to it often.  It expanded my knowledge and provided insight into things I didn't even know were important on the business side of the office." 

- Vanessa M Lankford, CPC, CMOM, AACE- CEC, Socioeconomic Coordinator, American Association of Clinical Endocrinologists (AACE)

 

“Even honest mistakes can trigger an audit. If your office gets on the radar of RACs, ZPICs, UPICs and other contractors commissioned by CMS, they will request the documentation that supports the claims for reimbursement that you have submitted to the Medicare program….if it’s not yours, you’ve got to pay it back!”

- Robert W. Liles, JD, MBA, MS, Managing Partner, Liles Parker, PLLC