Certification Training

Prod ID: 122
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. UPDATED FOR 2020

Test your knowledge with our free Medical Office Compliance Assessment.

CEUs

25

Length

1500 min

Price

$2095


The Certified Medical Compliance Officer addresses the unique compliance concerns in non-hospital health care provider offices. This updated course is for current and aspiring Compliance Officers working in small- to mid-sized outpatient medical office settings, home health, hospice, DME, PT clinics, and 3rd party billing companies.

The Certified Medical Compliance Officer addresses the unique compliance concerns in non-hospital health care provider offices. This updated course is for current and aspiring Compliance Officers working in Physician Practices, Home Health Agencies, Hospice Companies, Durable Medical Equipment Companies, Physical Therapy Clinics, Third-Party Billing Companies and other small to mid-sized health care provider entities.

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.

This curriculum has been widely lauded by participants and it is believed to be the most comprehensive, targeted compliance certification program currently available to small and mid-sized health care provider organizations and was recently approved for physician Continuing Medical Education credit.

Robert W. Liles, JD, MBA, MS and Paul Weidenfeld, JD


Robert W. Liles, JD, MBA, MS

Robert has worked in regulatory compliance as a Federal prosecutor and as defense counsel, for more than 25 years. Robert focuses his practice on fraud defense, internal audits, investigations, compliance and regulatory matters. He has represented both individuals and entities in administrative and civil proceedings and in connection with internal compliance reviews.

Robert is a nationally recognized speaker and educator on legal and regulatory issues. His extensive health care management education / background and his prior experience as a federal prosecutor provide a real-world perspective when advising individuals and entities on enforcement and regulatory compliance issues. He has also represented health care providers in connection with government regulatory investigations and audits by UPICs, ZPICs, SMERCs, RACs and reviews by SIUs working for private payor plans.

He holds master's degrees in both Business and Health Care Administration. After graduating from law school, he was hired as an Assistant United States Attorney (AUSA) in the Southern District of Texas (SDTX) primarily to handle False Claims Act matters and cases. He was later promoted to serve as Chief of the Financial Litigation Unit. Shortly after the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Robert was asked to serve as the first National Health Care Fraud Coordinator and was later promoted to the position of Deputy Director, Legal Programs, for the Executive Office for U.S. Attorneys (EOUSA), a component of the United States Department of Justice (DOJ) where he advised on civil and criminal fraud statutes, schemes, investigative tools, privacy concerns, and compliance issues. He was instrumental in writing and implementing DOJ guidance on the judicious use of the False Claims Act. Robert received "Director's Award," the highest award that can be bestowed by the agency, for his work.

Paul Weidenfeld, JD

Paul Weidenfeld is nationally recognized for his work in both the prosecution and defense of Healthcare Fraud investigations, False Claims Act cases and qui tam litigation. He has earned numerous awards including the prestigious Attorney General Award for Fraud Prevention and Nightingale Outstanding Healthcare Litigator.

A former Health Care Fraud Coordinator for the Executive Office of the Department of Justice, Paul has represented providers and individuals in Healthcare Fraud matters since leaving the department. Whether serving as mediator, litigation consultant or legal representative, or trying to understand and help craft solutions to even the most difficult litigation problems, Paul draws upon a broad range of experiences as a lawyer/litigator that includes over 50 trials, 25 appellate arguments and appearances before the United States Supreme Court, Federal and State Appellate Courts, and Federal and State trial courts.

He has also represented health care providers in connection with government regulatory investigations and audits by UPICs, ZPICs, SMERCs, RACs and reviews by SIUs working for private payor plans. He brings a unique perspective to False Claims Act cases, Fraud Investigations and Qui Tam, or whistleblower, lawsuits which is partly the result of his rare combination of having BOTH extensive litigation experience (more than 50 trials and 25 appellate) AND subject matter expertise (10 years as a fraud prosecutor, 2 years as the DOJ Healthcare Fraud Coordinator, and experience as a partner in a major healthcare law-firm). Paul's experiences have taught him that there is no one-size-fits-all in the world of settlement or conflict resolution, and he is well known for his ability to find innovative solutions to difficult litigation problems.

The CMCO curriculum 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. Your compliance program extends beyond the maintenance of policies and PHI. It represents an ongoing effort to operate a medical practice or clinic in an ethical manner within the four corners of the law.

A cookie-cutter compliance plan won't do.

A template downloaded from the Internet won't meet federal compliance expectations.

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 and penalties can add up quickly.

The CMCO Certification training covers every aspect of compliance in an outpatient medical office or facility. The training manual is packed with reference materials and resources, and tactical skills needed to develop and maintain a custom program that complies with federal guidelines and fits your unique requirements. Equally important, if you are audited, the training provides proof that your organization has taken steps to comply with applicable billing and coding rules.

An effective 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. This includes meeting regulatory obligations and minimizing threats to the organization.

The CMCO is created for non-hospital healthcare professionals. Experience working in a medical office is recommended for this course.

The material covered in this program represents a tremendous amount of information and real-world experience, systematically presented during each session. Don't be intimidated. This program was carefully developed by well-tenured healthcare compliance experts, nationally known Healthcare Compliance Attorney Robert W. Liles, and longtime Compliance Officer D.K. Everitt. They know the subject matter inside and out.

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 instructors, Robert Liles and Paul Weidenfeld, are healthcare attorneys with significant expertise who are intimately involved in the business of healthcare compliance and management.

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 invesigation 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.

Online Training

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

 

Request Exam

Exam Request Form

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.

"I ran across this quote from a 1920 Supreme Court case. It encapsulates all that we have been trying to teach in our CMCO course:

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