Evaluation and Management (E/M) claims are an ongoing audit risk requiring human oversight. Top carrier audit triggers include repeated E/M billing problems with a carrier, failure to follow non-par Medicare rules, higher than normal distribution of E/M levels of care or a single code, failure to routinely collect deductibles and copays, and random selection by private and government carriers.
The OIG says a coding compliance plan should include regular auditing and monitoring of claims. Don’t wait for an audit letter! The Certified Medical Chart Auditor-E/M (CMCA-E/M) provides the training needed to minimize risk areas associated with E/M coding and documentation – an important piece of the practice revenue cycle.
This certification program is ideal for experienced medical office coders with an interest, experience, and career aspirations in coding and compliance in an outpatient healthcare setting. Learn how to analyze medical records to determine whether the documentation supports CPT and medical necessity based on established coding and insurance carrier guidelines. Complete guided chart audit exercises derived from real case studies. The course includes guided instruction, physical workbook and chart audit tools.
Baseline skills include familiarity with E/M coding, regulatory guidelines, carrier medical claim policies, and compliance in a medical office. Knowledge of medical terminology and anatomy and physiology is beneficial. Important personal attributes include strong attention to detail, communication, and organizational skills.
A coding certification lays the foundation for advancement into an auditing role. Candidates with fewer than two years of outpatient coding experience will greatly benefit from the following courses available in PMI’s Online Training Center prior to enrollment in CMCA-E/M:
PMI Basics: Introduction to E/M Coding
Mastering E/M Coding
E/M Chart Auditing for Physician Services
No supplementary resources are required for this course or exam.
The CMCA-E/M is tailor-made for physician offices. The curriculum places emphasis on evaluation and management coding rules, medical necessity and proper E/M code selection. Participants will learn how to identify documentation deficiencies, as well as consequences and penalties for improper payments for E/M services.
- Medical record compliance for the medical office
- The role of a medical record auditor
- Coding and documentation for E/M services
- Review of history, exam and medical decision-making
- Difference between medical decision-making and medical necessity
- Recordkeeping, clinical documentation improvement, and physician queries
- Systematic instruction for conducting a formal chart audit
- E/M coding risk areas and compliance
- Regulatory actions and consequences for improper payments
- Local MAC guidelines for E/M auditing
- Comprehensive Error Rate Testing (CERT) and improper payment rates
- Guided E/M case studies with auditing tools
Course materials include a manual with coding guidelines, reference documents from the OIG and CMS, step-by-step auditing tools, and case studies.
Attend instructor-led classroom sessions, hosted in select hospitals, healthcare organizations, medical societies and colleges across the U.S.
Live Certified Medical Chart Auditor – E/M classroom format includes a full course manual, guided case study exercises, exam review, and timed, four-hour proctored certification exam. A score of 70% or better is required to earn the CMCA-E/M certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.
Participate in the Certified Medical Chart Auditor – E/M course remotely with access to a series of seventeen 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 with guided case study exercises, exam review, and timed, four-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 CMCA-E/M certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.
Start the Certified Medical Chart Auditor – E/M online training program anytime with access to seventeen pre-recorded, instructor-led sessions.
The Certified Medical Chart Auditor - E/M on demand format includes a full course manual, guided case study exercises, exam review, and timed, four-hour proctored certification exam. A score of 70% or better is required to earn the CMCA-E/M certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.
Experienced professionals may choose to challenge the Certified Medical Chart Auditor – E/M certification exam for a $299 fee.
Exam challenge fee includes a basic exam guide and a timed, four-hour proctored exam, scheduled by PMI’s Exam Coordinator in testing centers near the candidate’s location. A score of 70% or better is required to earn the CMCA-E/M certification. If a passing grade is not achieved on the first attempt, candidates may re-test for an additional fee.
Q. How many questions are on the exam and how much time is allocated?
The exam is a four-hour, timed, open book exam proctored in the participant’s local community. Candidates will complete 130 multiple-choice questions; 104 will apply directly to auditing eight E/M patient encounters from various specialties. The remaining questions cover documentation standards, key components of the encounter, and compliance.
A passing score of 70% is required to earn the credential.
Q. Is a review session offered?
Yes, each live class includes an in-class review on the second day with guided case study audit exercises. Live webinar and Online Training course both include a bonus review session in the student’s online portal.
Q. Will this credential help me advance my coding career?
Yes, it can! More coding positions are seeking coders with auditing skills.
"A clean claim should be paid in about 15 days. If a claim is denied, it could take anywhere from 30-120 days to get it paid. It takes a team to code properly and routine audits are an essential part of a healthy revenue cycle. More of our coding positions now require auditing skills.”
- Libby Purser, CHI, CMC, CMIS, CMOM, CPC, CRC, HIM Supervisor for a North Texas multi-specialty provider network, and PMI Director of Associate Faculty Development
Get your questions answered!
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