The certification program will prepare you to review the structure of the medical record, coding, and documentation guidelines for 1995, 1997, and new E/M guidelines for Office or Other Outpatient Visits in 2021. Take the Medical Chart Auditing Assessment to see if you're ready.
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 interest, experience, and career aspirations in coding and compliance in an outpatient healthcare setting.
CMC, CMIS, CMOM, CMCA-E/M
Jimmie has traveled the country teaching physicians, medical practice administrators and staff about the latest issues in medical practice management. Her background includes management of several multi-physician, multispecialty clinics.
She is aCertified Medical Coder (CMC), Certified Medical Office Manager (CMOM), Certified Medical Insurance Specialist (CMIS), and Certified Medical Chart Auditor E/M (CMCA-E/M). Additionally, she has special expertise in the areas of human resource management and patient advocacy.
Jimmie has conducted managed care contract analyses and negotiation and has extensive training and experience in diagnostic and procedural coding as well as effective reimbursement and collections techniques. She is well-versed in Medicare issues, coding and compliance. Her articulate, down-to-earth communication style makes her one of PMI's most sought-after speakers.
Students in this course will 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 and learn how to establish an internal E/M audit program in a medical office. The workbook materials include training and audit tools for hands-on practice according to 1995, 1997, and 2021 guidelines.
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:
No supplementary resources are required for this course or exam. A CPT code set manual is optional.
The CMCA-E/M is tailor-made for physician offices. Analyze medical records to determine whether the documentation supports CPT and medical necessity, and minimize risks associated with outpatient E/M claims. 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. The course workbook includes audit tools for hands-on practice according to 1995, 1997, and 2021 guidelines.
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)
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 (free shipping included in purchase). 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, plus access to recordings from the live series after the original recording date. Attend live, instructor-led training in live, 60-minute intervals, broadcast online over 8 consecutive weeks.
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.
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.
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
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