Certified Medical Chart Auditor - E/M (CMCA-EM)®

Take your career to the next level! You will take the skill and certification with you wherever you go, and your employer will benefit from your in depth training in E/M auditing. Evaluation and Management (E/M) claims remain 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 states 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) program will equip you with the knowledge needed to minimize risk areas associated with E/M coding and documentation - an important piece of the practice revenue cycle.

This certification course is ideal for experienced medical office coders with interest and career aspirations in coding and compliance in an outpatient healthcare setting.

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 the latest E/M guidelines.

The CMCA-E/M is tailor-made for provider offices. Learn how to 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 detailed course workbook includes audit tools for hands-on practice.

Course Outline:

• Medical record compliance for the medical office
• The role of a medical record auditor
• Coding and documentation for E/M services
• Review elements of medical decision making
• Using time vs. MDM
• Difference between medical decision making and medical necessity
• Recordkeeping, clinical documentation improvement, and physician queries
• Systematic instruction for conducting a formal chart audit
• E/M coding risk areas and compliance
• Regulatory actions and consequences for improper payments
• Comprehensive Error Rate Testing (CERT) and improper payment rates
• Guided E/M case studies with auditing tools

Course materials include a manual with coding guidelines, reference documents from the OIG and CMS, step-by-step auditing tools, and case studies.

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 can provide the foundation for advancement into an auditing role. Candidates with fewer than two years of outpatient coding experience may benefit from one or more of these foundational courses prior to enrollment in CMCA-E/M:

• PMI Basics: Introduction to E/M Coding
• Mastering E/M Coding
• Billing Requirements for E&M Services in 2023

Course materials include a manual with coding guidelines, reference documents from the OIG and CMS, step-by-step auditing tools, and case studies.