Online Training Course

Certified Medical Chart Auditor-E/M (CMCA-E/M)®

Training and audit tools to establish an internal E/M audit program in a medical office. Learn how to analyze medical records to determine whether the documentation supports CPT and medical necessity, and minimize risks associated with outpatient E/M claims.

CEUs

12

Length

480 min

Price

$795


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.

Pam Joslin

MM, CMC, CMIS, CMOM, CMCO, CMCA-E/M, CEMA


Pam has more than 20 years of medical practice management, coding, reimbursement and compliance experience. She has managed in medical practices ranging from single to multi-specialty groups, including ASC. She is an advocate of process improvement and maximizing and empowering your employees to bring about the "best practice" results for your organization. She received her Master's in Management from University of Phoenix. She maintains memberships in professional organizations to support her continuing cycle of learning in the ever-changing healthcare industry. Prior to joining the PMI Instructor team she was an Adjunct Instructor and served on three advisory boards at a community college in San Antonio.

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

 

Required Materials

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.

Course Outline:

  • 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.

CMCA-E/M training is available in three learning formats:

Live Classroom Training

Participants meet two consecutive 8-hour days (available in limited markets)

·        Day 1 - 8 hours of instructor-led lecture and workbook review

·       Day 2 – morning review guided case study exercises and review for the exam; after lunch take the four-hour timed exam.

Online Training Course

Review course lecture and complete workbook exercises at your own pace. Participants receive a physical course manual with audit tools and case study exercises. Online access is available for up to one year.

Live Webinar Course

Participants enrolled in the live webinar course receive the same materials as the Online Training Course above, including access to recordings from the live series after the original recording date. Attend live, instructor-led training in live, 90-minute intervals, broadcast online over 8 consecutive weeks.  Watch PMI’s website for live CMCA-E/M opportunities.

Exam

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.

Exam Request Form

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!

Our customer service team is available M-F, 8-5 Central.

Email CMCA-E/M Web Inquiry

Call 800-259-5562

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