Online Training Course

A coding credential provides the foundation to advance into a chart auditing role. Key auditing skills include familiarity with regulatory guidelines and carrier medical policies, attention to detail, knowledge of medical terminology and anatomy, strong communication and organizational skills, and an understanding of all areas of compliance in the medical office.

Earning the CMCA-E/M certification brings everything together to validate an audi - tor’s capability to scrutinize the medical record and manage E/M compliance efforts.

“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 TX multi-specialty provider network 

A smart device to look up medical terminology information or a CPT code set manual and a medical dictionary may be utilized for the course and exam.

E/M Chart Auditing for Physician Services / 3 Hrs / 3 CEUs

Improve knowledge of level-of-service audits with a step-by-step process for implementing an internal audit program to reduce practice risk and promote accurate claim submission.

Certified Medical Chart Auditor-(E/M) / 8 Hrs / 12 CEUs

Learn how to establish an internal E/M audit program for a medical office. Learn medical records analysis 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 workbook materials include training and audit tools for hands-on practice according to 1995, 1997, and 2021 guidelines.

These programs include everything needed to establish and maintain an E/M auditing program in an outpatient setting. Course materials contain some of the best research and resource materials available. 

Throughout the courses and exercises, the instructor will impart the importance of core knowledge and attributes: medical terminology and anatomy, attention to detail, strong organizational skills, along with the ability to maintain confidentiality and communicate with providers in a professional manner.  Certification candidates will put new skills into practice using auditing tools with hands-on auditing exercises from real case studies.

The two courses include everything needed to establish and maintain an E/M auditing program in an outpatient setting. Certification candidates will put new skills into practice using auditing tools with hands-on auditing exercises from real case studies. Curriculum areas of focus:

• The role of medical records auditor and compliance in the medical office

• Correct coding guidelines and carrier policies

• Coding and documentation of E/M services

• Accurate E/M code selection

• Establishing a Clinical Documentation Improvement program

• Review of history, exam, and medical decision-making

• Documenting medical necessity and the presenting problem

• Recordkeeping, clinical documentation improvement, and physician queries

• Steps for conducting a formal chart audit

• E/M coding risk areas and compliance

• Medicare compliance plan

• Common causes for carrier audits

• Regulatory actions and consequences for improper payments • Medicare Administration Contractor (MAC) • Comprehensive Error Rate Testing (CERT)

• Guided E/M case study activity and review

Throughout the courses and exercises, the instructor will impart the importance of core knowledge and attributes: medical terminology and anatomy, attention to detail, strong organizational skills, along with the ability to maintain confidentiality and communicate with providers in a professional manner.

“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 TX multi-specialty provider network

“The Office of the Inspector General says if you bill Medicare, your coding compliance plan should include regular auditing and monitoring. If improper payments are detected and an auditor contacts your office, your best line of defense is to have established practice standards and procedures, training and education, and transparency. 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 Managing Member of Liles Parker, PLLC, Washington D.C.

“In 2015, it was imperative that Hendrick locate a well-established, EXPERT training partner to instruct our providers in ICD-10 E&M coding.  After an extensive search and interview process, PMI was the clear choice.  The training and certification opportunities with PMI allowed Hendrick Provider Network to build and implement career ladders for numerous employees. In turn, these educational and career ladder opportunities have driven greater employee confidence, increased employee and physician engagement, and ultimately created superior patient confidence and satisfaction in their entire healthcare team.

As a result of our continued partnership with PMI, Hendrick has been able to provide 17 employees with CMC certification, 17 employees with CMOM certification, 8 employees with CMCA-EM certification, 35 employees with Medical Front Office Skills certification and 11 employees with CMCO certification and we look forward to our continued partnership with PMI.  Together, we can make significant strides in healthcare education which will ultimately help provide better patient care.”   - Marjohn Riney, BA, CMPE, CMCO, Operations Manager, Hendrick Health Abilene, TX

Does your office follow correct E/M coding guidelines? Red flags include increased denials, EHR automation features with pre-selected codes or coders with insufficient training in E/M coding guidelines. Don’t get buried in denials! Don’t wait for an audit letter! Experts say your best line of defense is to have an established auditing process, properly trained staff, transparency, and good legal representation.

Audit triggers include:

• Repeated E/M billing problems with a carrier

• Failure to follow non-par Medicare rules

• Medical records that do not support the CPT or E/M code(s)

• Failure to routinely collect deductibles and co-pays

• Failure to perform random E/M audits on a consistent basis

• Random selection by private or government carriers

• Higher than normal distribution of E/M levels of care or a single codeAn ongoing E/M auditing process protects the practice by flagging problems before submission, thereby reducing denials and rework of claims.

The OIG encourages individual and small group physician practices to incorporate a compliance plan that includes internal monitoring and auditing of claims. This demonstrates a good faith effort to minimize errors and prevent improper billings before they occur. - The Seven Basic Components of a Voluntary Compliance Program