Medical Auditing Boot Camp – Professional Services

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Medical Auditing Boot Camp – Professional Services

Product Code: MABC

Bring our industry-leading faculty on-site to teach this class for your staff!

Call us at 877-233-8734 for more information.

Check back for new Boot Camp dates!

Medical Auditing Boot Camp – Professional Services

Course Overview

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
  • Payer staff
  • Consultants
  • 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).

For more detailed information about HCPro's Boot Camps, contact customer service at 800-650-6787 or email

Medical Auditing Boot Camp – Professional Services

Course Locations & Dates

Check back for new Boot Camp dates!

Medical Auditing Boot Camp – Professional Services


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.
  • Identify the coding systems applicable to professional medical record audits
  • 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 2 – 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
  • Identify the Civil Monetary Penalties associated with specific violations and entities
  • 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 & Medicaid Services (CMS) program oversight
  • Understand the role and function of the CMS Recovery Audit Program

Module 3 – Documentation Guidelines and Medical Records

  • Understand the medical record as a legal documentation
  • Identify the necessary components of medical record documentation
  • 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
  • Demonstrate an understanding of the documentation requirements of operative reports, and diagnostic testing and laboratory reports
  • Abstract, audit, and verify the medical record based on type of service
  • Correctly interpret teaching physician guidelines and demonstrate an understanding of documentation requirements

Module 4 – Evaluation and Management Categories

  • Identify the categories of E/M codes
  • Apply the CPT E/M category guidelines
  • Define the common symbols and terms used in the CPT book
  • Accurately assign E/M codes by category
  • Accurately assign appropriate E/M modifiers
  • Identify when to apply 99211 services and who can report them

Module 5 – Evaluation and Management Level Assignment

  • Identify history of present illness (HPI) terms and definitions
  • Identify terms in documentation and assign them to the HPI
  • Understand and apply the HPI documentation guidelines
  • Identify the review of systems (ROS) able to understand and apply the review of system documentation guidelines
  • Identify past personal, family, social, history (PFSH)
  • Identify terms in the documentation and assign them to the PFSH
  • Assign the overall history using the history elements
  • Identify organ system and body areas of the examination
  • Understand and apply the examination guidelines appropriately
  • Identify medical decision making
  • Understand and apply the medical decision making elements
  • Assign E/M codes by level
  • Apply E/M knowledge and effectively utilize E/M tools

Module 6 – Procedures and Surgical Services

  • Apply correct coding for surgical, radiology, pathology, and medicine services
  • Demonstrate an understanding of HCPCS Level II codes and correct coding assignment
  • Correctly append surgical service modifiers
  • Correctly assign CPT and HCPCS Level II modifiers
  • Identify a “separate procedure” and when they are reported
  • Demonstrate an understanding of NCCI and application of appropriate modifiers
  • Identify medically unlikely edits and appropriately apply/audit edits

Module 7 – National Correct Coding Edit Initiative (NCCI)

  • Present an understanding of NCCI and MUE edits
  • Access NCCI files and the NCCI policy manual
  • Demonstrate an understanding of PTP, MUE, and add-on code edit files
  • Identify NCCI associated modifiers
  • Apply NCCI edits accurately to ensure correct coding

Module 8 – The Audit Process

  • Demonstrate an understanding of types of audits
  • Identify audit process and associated steps
  • Demonstrate an understanding of audit sampling: random, focused, and statistically valid
  • Identify audit type based on audit focus
  • Demonstrate an understanding of coding vs. payer guidance
  • Understand the importance of E/M bell curve profiling and how to use the information as a guide for audit and compliance

Module 9 – Audit Outcome, Implementation and Follow-up

  • Demonstrate an understanding of implementation of audit findings
  • Identify components of a corrective action plans
  • Identify self-disclose audits
  • Demonstrate an understanding of Corporate Integrity Agreements and the role of Independent Review Organizations

Course outline/Agenda subject to change.

Medical Auditing Boot Camp – Professional Services

Learning Objectives

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.

Medical Auditing Boot Camp – Professional Services

Continuing Education Credit

This program has the prior approval of AAPC for 28 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

American Health Information Management Association (AHIMA)
This program has been approved for 28 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

Medical Auditing Boot Camp – Professional Services

Questions and Answers

What is the focus of the Medical Auditing Boot Camp - Professional Services?
The focus is on teaching Medicare-based regulations and guidelines applicable to professional services. Participants will learn about the applicable coding classification systems utilized for reporting professional services (ICD-10-CM, CPT, and HCPCS II, including modifiers) and the typical audit focus areas.

Where is the course offered?
Open registration sessions are offered at various locations around the country, typically at mid-priced business hotels such as HYATT Place or Hilton Garden Inn. For a current schedule of upcoming open registration courses, click on "Locations/Dates" above.

Does HCPro offer an "on-site" version of this Boot Camp?
In addition to our open registration courses, we also offer this boot camp as an on-site program (with a substantial discount) for organizations that have a number of employees who need training. For more information on hosting an on-site boot camp, click on Host an On-Site Course.

What if I need to cancel or transfer my registration?
To view our cancellation policy, click here.

Who typically attends the Medical Auditing Boot Camp - Professional Services?
The attendees are typically physician practice staff, including billers, auditors, and practice managers. Other attendees include consultants and auditors who review physician service records.

What material does the course cover?
To view the course outline, click on "Course Outline" above.

Does the course require any previous experience or training?
No. The course starts with Medicare fundamentals and does not assume that participants have any particular background or experience. However, because of the fast-paced nature of the course, it is highly recommended (but not required) that participants have at least one year of experience working with professional service coding or billing.

How is the course taught?
The course is taught using a combination of lecture, class discussion, and hands-on exercise/case studies.

What do I need to bring to class?
When you arrive at class, you will receive an extensive notebook of course materials. In addition, please bring the following to all classes:
• A highlighter
• A notebook for taking notes
• Sticky notes/flags
• A pen/pencil
• CPT Manual

Do I need to bring my own coding manuals to class?
You will need the current year of the AMA CPT® 2018 Professional Edition, ICD-10-CM Expert for Physicians, and a HCPCS Level II manual for the class. We will be providing you the latest versions of ICD-10-CM Expert for Physicians, and HCPCS Level II.

Does HCPro ever share contact information (e.g., name, address, phone number, email address, etc.) with other companies?
Historically, we have not shared contact information with anyone outside of our company. However, it is possible that at some point we might share contact information with other companies that offer products and services that we think would be of interest to our customers. If you would like us to keep your contact information confidential, please let us know so that we can flag your information in our customer database as "Do Not Share."

How do I get more information?
Contact customer service at 800-650-6787 or email