The certification program will prepare you to review the structure of the medical record, coding, and documentation guidelines for 1995, 1997, and new E/M guidelines for Office or Other Outpatient Visits in 2021.
Evaluation and Management (E/M) claims are 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 says 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) provides the training needed to minimize risk areas associated with E/M coding and documentation – an important piece of the practice revenue cycle.
This certification program is ideal for experienced medical office coders with interest, experience, or career aspirations in coding and auditing in an outpatient healthcare setting. 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.
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 1995, 1997, and 2021 guidelines.
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Jimmie HebertCMC, CMIS, CMOM, CMCA-E/M |
Jimmie has traveled the country teaching physicians, medical practice administrators and staff about the latest issues in medical practice management. Her background includes management of several multi-physician, multispecialty clinics.
She is aCertified Medical Coder (CMC), Certified Medical Office Manager (CMOM), Certified Medical Insurance Specialist (CMIS), and Certified Medical Chart Auditor E/M (CMCA-E/M). Additionally, she has special expertise in the areas of human resource management and patient advocacy.
Jimmie has conducted managed care contract analyses and negotiation and has extensive training and experience in diagnostic and procedural coding as well as effective reimbursement and collections techniques. She is well-versed in Medicare issues, coding and compliance. Her articulate, down-to-earth communication style makes her one of PMI's most sought-after speakers.
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 auditor’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
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 lays the foundation for advancement into an auditing role. Candidates with fewer than two years of outpatient coding experience will greatly benefit from the following courses available in PMI’s Online Training Center prior to enrollment in CMCA-E/M:
PMI Basics: Introduction to E/M Coding
E/M Chart Auditing for Physician Services
No supplementary resources are required for this course or exam.
The CMCA-E/M is tailor-made for physician offices. 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 course workbook includes audit tools for hands-on practice according to 1995, 1997, and 2021 guidelines.
Course Outline:
Course materials include a manual with coding guidelines, reference documents from the OIG and CMS, step-by-step auditing tools, and case studies.
CMCA-E/M training is available in three learning formats:
Live Classroom Training
Participants meet two consecutive 8-hour days (available in limited markets)
· Day 1 - 8 hours of instructor-led lecture and workbook review
· Day 2 – morning review guided case study exercises and review for the exam; after lunch take the four-hour timed exam.
Online Training Course
Review course lecture and complete workbook exercises at your own pace. Participants receive a physical course manual with audit tools and case study exercises (free shipping included in purchase). Online access is available for up to one year.
Live Webinar Course
Participants enrolled in the live webinar course receive the same materials as the Online Training Course above, including access to recordings from the live series after the original recording date. Attend live, instructor-led training in live, 90-minute intervals, broadcast online over 8 consecutive weeks. Watch PMI’s website for live CMCA-E/M opportunities.
Exam
The exam is a four-hour, timed, open book exam proctored in the participant’s local community. Candidates will complete 130 multiple-choice questions; 104 will apply directly to auditing eight E/M patient encounters from various specialties. The remaining questions cover documentation standards, key components of the encounter, and compliance.
“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
The exam is a four-hour, timed, open book exam proctored in the participant’s local community. Candidates will complete 130 multiple-choice questions; 104 will apply directly to auditing eight E/M patient encounters from various specialties. The remaining questions cover documentation standards, key components of the encounter, and compliance.
A passing score of 70% is required to earn the credential.
Yes, each live class includes an in-class review on the second day with guided case study audit exercises. Live webinar and Online Training course both include a bonus review session in the student’s online portal.
Yes, it can! More coding positions are seeking coders with auditing skills.
"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 Texas multi-specialty provider network, and PMI Director of Associate Faculty Development
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