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.
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Jan Hailey
MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
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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.
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.
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.
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.
“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
Q. How much time is allocated for the examination, and what is the cut score?
The exam is a four-hour, timed, proctored, open book exam. A passing score of 70% is required to earn the credential.
Q. What type of test format is used?
Candidates must complete multiple-choice questions directly related to their audit of numerous E/M patient encounters from a variety of specialties plus general questions related to E/M documentation standards, components of the patient encounter, and compliance.
Q. Will this credential help me advance my coding career?
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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