Online Training Course

Jan Hailey MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M

Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program. 

Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.

Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.

The Certified Medical Coder is a leading certification for medical coding professionals that work with outpatient claims. The training program prepares candidates with advanced knowledge of the reimbursement cycle from patient encounter to claim. These skills are imperative for proper claim submission and accurate payment for services rendered.

For employers, auditors, and business associates, CMC signifies an ongoing commitment to continued professional development. Those who continue to expand their professional knowledge will have an edge in today's ever-changing healthcare climate.

Benefits of becoming/hiring a Certified Medical Coder:

• A CMC protects the practice’s financial health by decreasing claim denials and improving billing accuracy and compliance with current guidelines
• A CMC does not rely on EHR presets, web searches or coding cheat sheets for coding assignments, which can cause repeat problems and trigger an audit
• A CMC communicates with confidence with physicians, third-party payers, patients, and business associates, which promotes advancement into chart auditing and supervisory roles.

The Certified Medical Coder (CMC) is designed for experienced coders that have a minimum of one year of work experience in outpatient medical coding. All candidates are encouraged to complete PMI’s free online Medical Coding Assessment to test their base knowledge and identify areas of deficiency where training may be beneficial in advance of the course. 

Fundamental Training Recommendation

Candidates with limited experience should complete the two primer courses included with CMC training: Medical Terminology for Coders and  Principles of Coding.

Required Self-Supplied Materials

Students must have access to current editions of CPT®, HCPCS, ICD-10-CM, and a medical dictionary throughout the course and on the exam day. These coding reference materials are updated annually. PMI certification course students should utilize coding resources that are current at the time of their participation in the course and exam. Candidates that schedule an exam appointment for the next calendar year should bring coding books that are current on the date of their exam.   

Students should be aware that the AMA publishes the only CPT® codebook with the official CPT guidelines. PMI does not sell medical coding books, but they are widely available for purchase or lease through a variety of nationwide publishers and retailers. 

Exam

Earning CMC certification requires a passing score of 70 percent or better on the written exam. All exams are proctored live in testing centers across the country. Candidates have up to six hours to review questions and coding books and write in their answers based on the criteria given. Codes selected must designate the highest degree of specificity based on the documentation provided using current coding reference books. Exams are hand-graded and verified twice. In an age of digitized grading systems designed to simplify the grading process, PMI stands by its resolute exam standards as the most accurate measure of a CMC candidate’s coding ability. 

Certified Professional Standards of Excellence

Practice Management Institute certified professionals are required to uphold high professional standards, established by the Practice Management Institute Advisory Board for Certification Programming. Ethics requirements include adherence to legal guidelines according to governmental and third-party payer organizations and contracts.

Maintaining the CMC Certification

Medical office professionals, particularly those working in reimbursement roles, must stay current on updates and changes each year. Keeping the CMC certification active requires an ongoing commitment to continuing education. Twelve hours of continuing education are required each year to maintain active certification status. For information about renewing the CMC certification, visit the “Certification Renewal” section of our website.

The CMC online preparatory course consists of 24 hours of high-level coding instruction led by a PMI-approved Instructor and a vast number of hand-on coding practice exercises.

Course Outline:

Medical Terminology

• Makeup and pronunciation of medical terms/words
• Key review of the human body systems, illustrations, and review of anatomic position and directional terms
• Root words, prefixes, suffixes, and supplemental terms
• Combined forms associated with medical conditions
• Definitions for common medical abbreviations
• Analysis of physician orders and narratives

ICD-10-CM Coding

• Instruction on the guidelines, organization, and groupings of ICD-10-CM
• Accurate translation of medical terminology for diseases into codes
• Designation of symbols, punctuations, abbreviations, keywords, unspecified codes, and other coding conventions
• ICD-10-CM subcategories, classifications, and extensions
• Outline of the complete coding and reimbursement equation
• Primary vs. secondary code selection
• Diagnostic coding guidelines such as laterality, sequelae, etc.
• Differentiate between signs/symptoms and ill-defined conditions and a diagnosis
• Correct rules and guidelines for assigning codes for neoplasms, adverse effects, pregnancy, childbirth, wounds, burns, injuries, HIV/AIDS, etc.
• Unsubstantiated and borderline diagnoses
• Application of ICD-10 coding conventions
• How to determine the accurate diagnostic code order
• Proper use of tables
• Problem set coding exercises for hands-on comprehension

Procedural Coding - CPT® and HCPCS

• Key elements of physician documentation that drive the assignment of CPT codes
• Accurate code assignment through the application of coding guidelines
• HCPCS/CPT coding process and steps
• Format and conventions used in the HCPCS/CPT coding manuals
• Global and unbundled procedures, and their impact on coding in CPT
• Identify unlisted procedures and how to bill them
• Modifier usage for appropriate reimbursement and efficient claims processing
• Evaluation and management service types
• E/M guidelines and levels of service
• Medical record documentation as related to the application of E/M coding
• Bundled services guidelines for surgery coding
• New versus established patient guidelines
• Surgery coding guidelines
• Hands-on exercises coding common procedures and services provided by physicians

Ancillary Services & Advanced Coding

• Maternity and delivery services
• Types of radiology services
• Technical and professional component distinction
• Billing supervision and interpretation (S&I) services
• Laboratory procedure types
• Billing for qualitative detection versus quantitative detection
• Billing laboratory panel tests
• Types of pathology services
• Coding services in the medicine section
• Billing for the administration of vaccines and immunizations
• Types of dialysis
• Guidelines used to assign ophthalmologic examinations
• Advanced coding problem set exercises 

“We hire a large number of remote coders. We recently considered a few of your credentialed coders and I have been extremely impressed. All of them scored far higher on our tests than anyone. Just as a reference, they basically outscored more than 350 other coders.”   -Doug McDonald, Outcomes Health Information Solutions, Inc.

“I came into this area after working at front desk scheduling.  I was not sure of the requirements for Evaluation and Management codes, proper listing of diagnosis codes, etc.  After taking your class, I realized how important the billing coder really is…. learning to read the office/hospital notes, what most insurance companies require for correct billing and how to provide this within a proper time frame.  Medical terminology is also a very important aspect of coding.  The wrong suffix or prefix can change the diagnosis.

Your class has allowed me to understand and to better code our office billing claims, coding to the highest degree possible. This has translated into fewer questioned claims by insurance companies, faster payments and more income. It has made my job easier and encouraged me to learn more.

I value the extra classes offered to keep medical professionals up to date with the current changes in medical coding, billing, and office management.  I look forward to expanding my knowledge in this area.”   - Carol Hicks, CMC

“I could not believe I learned so much in such a short time. The teacher was wonderful, and I received my certificate right on time!”   - Missy Davis, CMC, Urology Associates of Central California

“I just wanted to take a moment and share with you how thankful I am for you guys. We honestly have been so anxious about the impending ICD10 roll out and have had a lot of anxiety with our Practice Software upgrades and changes. We’ve been trying to get prepared and I honestly can say that Pam coming here to guide us and teach us as a team and practice has been so critically necessary. We feel as though Pam had an amazing insight, great resource, and a perfect teacher for us. Thank you both for your efforts on getting "operation ICD10” underway with our practice. Couldn’t have done it without you guys!”   - Chaya Burson, Office Manager, Barker Bariatric Center, Dallas, TX

“My previous job was Practice Administrator in an OBGYN practice for 17 years. PMI was responsible for my landing a fantastic job as Director of Billing at a very large Neurosurgery practice. One of the requirements was being a certified coder. I am very grateful for PMI. I have learned skills that have made me marketable and a great success in the field!”   - Naomi Ziemba, CMC

“I wanted to share my comments on why it is so important to be certified in the medical field these days. I am a certified medical coder & have received my CMC thru PMI in August of 2006 with the help and hard work of my instructor Rose Moore. I recently made the move from Danville VA to Rock Hill SC. My certification played a major role in why I was hired in May 2009 with my employer here in Rock Hill SC. Also, the economy was uncertain in early 2009. I was offered a great job at Digestive Diseases Associates at their newest state of the art Endoscopy Ambulatory surgery center in Rock Hill. The physicians here told me that being certified is very important because it shows that an employee is not only qualified for the job, but also cares about the job that they are hired to do.

So, when it comes to getting that certification in your field getting there is a commitment and you also will have a great time doing it! And all of the people you meet makes it all the more fun and interesting!”   - Patty Tesch, CMC Rock Hill , SC

“I found the class very helpful. It showed me how to use the coding books properly and research details. Thank you again for being a gracious host!”   - Cecelia Alviderez, CMC, Biller, Fresno Nephrology Medical Group

“The instructor was great! I really liked that the curriculum was based on how the structure of the exam would be.”   - Christina Soriano, CMC, Billing Supervisor, Omni Women’s Health Medical Group