Boot Camps

Medical Auditing Boot Camp Online

Course Overview

The Medical Auditing Boot Camp Online teaches you how to conduct an affective audit in a convenient self-paced format.

The Boot Camp covers the entire audit process, from learning about what coding and billing elements are reported through how to interpret and respond to audits.

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. But if they learn about the latest regulations and coverage guidance, physician offices can reduce vulnerability to Medicare contractor audits (e.g., UPIC, SMRC, RAC/RA).

The Boot Camp delves into coding and 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 audit evaluation and management (E/M) codes, including modifiers
• Perform successful professional services audits
• Identify how to implement a corrective action plan

For more information about our Boot Camps, contact us at 615-724-7200 or email PD-IS@SimplifyCompliance.com.

Medical Auditing Boot Camp Online

Dates

Below is the current course schedule for upcoming Medical Auditing Boot Camp Online classes.

To view our cancellation policy, click here.

Medical Auditing Boot Camp Online

Course Outline/Agenda

Module 1 – Overview of Professional Services Auditing and ICD-10-CM, CPT, and HCPCS Coding Concepts

• Professional service auditing, its purpose, and types of audits performed
• Coding systems applicable to professional medical record audits
• How to locate and utilize source authorities required for professional medical record auditing
• Certifications available for medical record auditing
• The role of the auditor

Module 2 – Documentation Guidelines and Medical Records

• HIPAA Overview and Privacy Rule
• The medical record is a legal document
• Identifying the necessary components of medical record documentation
• Documents and forms of the medical record:
  • Registration
  • Benefit Assignment
  • Privacy Notice Receipt
  • Release of Information
  • Advanced Beneficiary Notices
  • Notice of Non-coverage
  • Consent
• Understanding the documentation requirements of operative reports, diagnostic testing, and laboratory reports
• How to abstract, audit, and verify the medical record based on type of service
• How to correctly interpret teaching physician guidelines and understand documentation requirements

Module 3 – Evaluation and Management Categories

• Categories of E/M codes
• Applying the CPT E/M category guidelines
• Common symbols and terms used in the CPT book
• Assigning Evaluation and Management codes by category
• Assigning appropriate E/M modifiers

Module 4 – Evaluation and Management Level Assignment

• History of present illness (HPI) terms and definitions
• Documentation terms and assigning them to the HPI
• Applying the HPI documentation guidelines
• Review of systems (ROS)
• Applying the review of system documentation guidelines
• Identifying past personal, family, social, history (PFSH)
• Identifying terms in the documentation and assigning them to the PFSH
• Assigning the overall history using the history elements
• Organ system and body areas of the examination
• Examination guidelines
• Elements of medical decision making
• Evaluation and Management codes by level
• E/M knowledge and effectively using E/M tools

Module 5 – Elements of Surgical and Other Professional Services

• Correct coding for surgical, radiology, pathology, and medicine services
• Correctly appending surgical service modifiers
• Assigning CPT and HCPCS Level II modifiers
• Identifying a “Separate Procedure” and when they are reported
• The auditor’s role in determining medical necessity
• Identifying National and Local Coverage Determinations

Module 6 – National Correct Coding Edit Initiative (NCCI)

• NCCI and MUE edits
• NCCI files and NCCI policy manual
• PTP, MUE and Add-on Code Edits files
• NCCI associated modifiers
• Applying NCCI edits accurately to ensure correct coding

Module 7 – The Audit Process

• Types of audits
• Audit process and associated steps
• Audit sampling:
  • Random
  • Focused
  • Statistically valid
• Audit type based on audit focus
• Coding vs. payer guidance
• E/M bell curve profiling and how to use the information as a guide for audit and compliance
• Implementation of audit findings
• Components of corrective action plans
• Self-disclose audits
• Corporate Integrity Agreements and the role of Independent Review Organizations

Module 8 – Regulations, Statutes, and Compliance

• Federal regulations:
  • False Claims Act (FCA)
  • Anti-Kickback Statute (AKS)
  • Physician Self-Referral Law (Stark Law)
  • Civil Monetary Penalties Law
  • Exclusion Statute
• Civil Monetary Penalties associated with specific violations and entities
• Role and function of the Office of the Inspector General
• Office of Inspector General’s Compliance Plans
• Centers for Medicare and Medicaid Services (CMS) program oversight
• Role and function of the CMS Recovery Audit Program

Course outline/Agenda subject to change.

Medical Auditing Boot Camp Online

Speaker

Jill Harrington, EdD, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, CEMC, MHP

Jill Harrington EdD, MHA, CPC, CPC-I, CPC-P, CCS, CCS-P, CEMC, MHP, is a regulatory coding specialist at HCPro, a Simplify Compliance brand in Middleton, Massachusetts. Dr. Harrington's background as a coder and as a chief compliance officer peppers her classes with real-life experience, whether she's teaching undergrads and graduate students, physicians, or coding professionals, resulting in a captivating teaching style that illuminates complicated coding rules and guidelines.

She serves as the instructor for the Certified Coder Boot Camp® and for the Hospital and the Medicare Boot Camp®—Physician Services. She also co-developed the Codercise® CPT Operative Report. Dr. Harrington has more than 20 years of experience in the healthcare profession. She is an approved instructor of the Professional Medical Coding Curriculum, awarded by the American Academy of Professional Coders, and teaches coding for physician and hospital services, as well as healthcare administration. She has spoken frequently on healthcare compliance and health information management issues at regional and national professional conferences.

Medical Auditing Boot Camp Online

Learning Objectives

At the conclusion of this educational activity, participants will be able 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 audit evaluation and management (E/M) codes, including modifiers
• Perform successful professional services audits
• Identify how to implement a corrective action plan

Continuing Education

AAPC
This program has the prior approval of AAPC for 12 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

AHIMA
This program has been approved for 12 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

NAHRI
This program has been approved for 12 continuing education units towards fulfilling the requirements of the Certification in Healthcare Revenue Integrity (CHRI), offered as a service of the National Association of Healthcare Revenue Integrity (NAHRI).

Medical Auditing Boot Camp Online

Questions/Answers

Medical Auditing Boot Camp Online: How does it work?
You’ll receive the same content and instruction that you would experience at our classroom-based, nationally recognized Boot Camps. Here’s how it works:

• 60-day access after purchase date: View sessions and complete assignments, including review of all answer keys.
• 24-hour access: Modules are available at any time of day—you choose the time that works for you. You can also email questions to our instructors. We try to answer all questions either via email or phone within two business days.

What is the focus of Medical Auditing Boot Camp Online?
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.

Does HCPro offer this Boot Camp as an on-site course?
In addition to our open registration courses, we also offer the 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, call 800-780-0584 or click on "Train Groups On-Site."

What if I need to cancel or transfer my registration?
Cancellation Policy
Please click here to view our cancellation policy.

Who typically attends this Boot Camp?
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.

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 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 us at 615-724-7200 or email PD-IS@SimplifyCompliance.com.