Medical Auditing Boot Camp – Professional Services
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Many physician practices, including independent practices, physician practice groups, and freestanding clinics owned by facilities, lack a medical documentation expert who is able to review and audit claims to ensure accuracy and compliance. This course will take participants through the entire audit process, from learning about what coding and billing elements are reported through how to interpret and respond to audits.
By learning about the latest regulations and coverage guidance, physician offices will reduce vulnerability to Medicare contractor audits (e.g., UPIC, SMRC, RAC/RA). Over the course of three-and-a-half days, this boot camp will delve into coding and other documentation issues unique to professional services – including appropriate application of modifiers, accurate E/M reporting, and the impact of value-based payment programs.
You will leave this program knowing how to:
Identify the coding systems and source authorities used for reporting and guidance in professional services Explain the role of federal auditing bodies, regulations, and penalties associated with fraud Accurately assign evaluation and management (E/M) codes, including modifiers Perform successful professional services audits Identify how to implement a corrective action plan
Who should attend?
Physician practice billers and auditors
Physician practice managers and administrators
Physician practice office or billing managers
Physician practice revenue integrity professionals
See the HCPro difference for yourself!
Focus on the rules: Learn how to find and apply Medicare rules and guidelines that apply to professional services to help ensure accurate and appropriate billing.
Tools and skills to navigate Medicare rules: Our instructors provide valuable tools and resources that will help you prioritize and research questions long after the Boot Camp ends.
Hands-on learning: Attendees work a set of exercises/case studies after each module to ensure they understand the concepts and know how to apply them to real-world situations.
Small class size: A low participant-to-teacher ratio is guaranteed.
Highly rated, well-established program: Participants consistently give HCPro Boot Camps an overall rating of 4.75 or higher (on a 5.0 scale).
At the conclusion of this educational activity, participants will be able to:
Demonstrate an understanding of professional service auditing, its purpose and types of audits performed.
Locate and utilize source authorities required for professional medical record auditing.
Demonstrate an understanding of available medical record audit certifications available.
Articulate the role of the auditor.
Module 1 – Overview of Professional Services Auditing and ICD-10-CM, CPT, and HCPCS Coding Concepts
Demonstrate an understanding of professional service auditing, its purpose and types of audits performed Be able to identify the coding systems applicable to professional medical record audits Be able to locate and utilize source authorities required for professional medical record auditing Demonstrate an understanding of available medical record audit certifications available Be able to articulate the role of the auditor
Module 2 – Documentation Guidelines and Medical Records
Demonstrate an understanding of HIPAA Overview and Privacy Rule Be able to understand the medical record as a legal documentation Be able to identify the necessary components of medical record documentation Be able to identify documents and forms of the medical record: Registration, Benefit Assignment, Privacy Notice Receipt, Release of Information, Advanced Beneficiary Notices, Notice of Non-coverage, and Consent Be able to demonstrate an understanding of the documentation requirements of operative reports, diagnostic testing and laboratory reports Be able to abstract, audit, and verify the medical record based on type of service Be able to correctly interpret teaching physician guidelines and demonstrate an understanding of documentation requirements
Module 3 – Evaluation and Management Categories
Be able to identify the categories of E/M codes Be able to apply the CPT E/M category guidelines Be able to define the common symbols and terms used in the CPT book Be able to accurately assign Evaluation and Management codes by category Be able to accurately assign appropriate E/M modifiers
Module 4 – Evaluation and Management Level Assignment
Be able to identify history of present illness (HPI) terms and definitions Be able to identify terms in documentation and assign them to the HPI Be able to understand and apply the HPI documentation guidelines Be able to identify the review of systems (ROS) Be able to understand and apply the review of system documentation guidelines Be able to identify past personal, family, social, history (PFSH) Be able to identify terms in the documentation and assign them to the PFSH Be able to assign the overall history using the history elements Be able to identify organ system and body areas of the examination Be able to understand and apply the examination guidelines appropriately Be able to understand and apply the medical decision making elements Be able to assign Evaluation and Management codes by level Be able to apply E/M knowledge and effectively utilize E/M tools
Module 5 – Elements of Surgical and Other Professional Services
Be able to apply correct coding for surgical, radiology, pathology, and medicine services Be able to correctly append surgical service modifiers Be able to correctly assign CPT and HCPCS Level II modifiers Be able to identify a “Separate Procedure” and when they are reported Understand the auditor’s role in determining medical necessity Identify National and Local Coverage Determinations
Module 6 – National Correct Coding Edit Initiative (NCCI)
Be able to present an understanding of NCCI and MUE edits Be able to access NCCI files and NCCI policy manual Demonstrate an understanding of PTP, MUE and Add-on Code Edits files Identify NCCI associated modifiers Be able to apply NCCI edits accurately to ensure correct coding
Module 7 – The Audit Process
Be able to demonstrate an understanding of types of audits Be able to identity audit process and associated steps Demonstrate an understanding of audit sampling: random, focused, and statistically valid Be able to identify audit type based on audit focus Be able to demonstrate an understanding of coding vs. payer guidance Be able to understand the importance of E/M bell curve profiling and how to use the information as a guide for audit and compliance Be able to demonstrate and understanding of implementation of audit findings Be able to identify components of a corrective action plans Be able to identify self-disclose audits and demonstrate and understanding Demonstrate and understanding of Corporate Integrity Agreements and the role of Independent Review Organizations
Module 8 – Regulations, Statutes, and Compliance
Demonstrate an understanding of the following Federal regulations: False Claims Act (FCA), Anti-Kickback Statute (AKS), Physician Self-Referral Law (Stark Law), Civil Monetary Penalties Law, Exclusion Statute Be able to identify the Civil Monetary Penalties associated with specific violations and entities Be able to understand the role and function of the Office of the Inspector General Demonstrate and understanding of the Office of Inspector General’s Compliance Plans Demonstrate an understanding of the Centers for Medicare and Medicaid Services program oversight Be able to understand the role and function of the CMS Recovery Audit Program
Course outline/Agenda subject to change.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, serves as the lead instructor for the Medical Auditing Boot Camp – Professional Services. She is a regulatory specialist teaching the Certified Coder Boot Camp® programs. As a seasoned instructor, she has extensive knowledge of not only professional services coding guidelines including E/M but she also possesses many years of experience in the healthcare industry, including coding, auditing, training, and compliance expertise for hospital inpatient and outpatient services. Prior to joining HCPro, Commeree was a coding auditor/medical assistance program specialist with the Washington State Health Care Authority (HCA)’s Clinical Review Unit, working within the state’s Medicaid program.
She also served as a coding consultant to other HCA departments by assisting providers, policymakers, and data analysts to identify aberrant coding patterns and potential fraud, waste, and abuse. Before working for Washington, she served as a coding specialist and trauma registrar with Trauma Trust, an organization that serves two major healthcare systems in the Tacoma area by providing Level II trauma and acute care surgical services.
Yvette M DeVay, MHA, CPC, CPMA, CIC, CPC-I, is the lead instructor for HCPro’s Medicare Boot Camp®—Physician Services Version. As a regulatory specialist, she also instructs the Certified Coder Boot Camp® (live and online) and the Evaluation and Management Boot Camp®. DeVay has extensive experience as a professional/outpatient coding consultant. She has assisted physician practices with coding integrity, internal audits, charge capture, and litigation defense. She served as the ICD-10 project manager for a state Medicaid agency, where she established the implementation schedule, steering committees, and workgroups; participated in gap analysis, policy review, and ICD-10 revisions; and oversaw departmentwide ICD-10 awareness and education.
An AHIMA-approved ICD-10-CM/PCS trainer, DeVay is accredited as a Certified Professional Coder, a Certified Inpatient Coder, and a Professional Medical Coding Curriculum (PMCC) instructor by the AAPC. She holds a Master of Health Administration from Seton Hall University and a Bachelor of Science in Applied Behavioral Sciences from Pennsylvania State University.
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|Ticket Information ||Ticket Price |
| Registration *** || USD 1,699|