Auditing Concepts


Medical Auditing requires knowledge of a variety of different aspects throughout the healthcare field. Our Auditing Courses and Learning Paths include medical record standards and documentation guidelines, coding and documentation compliance, coding and reimbursement concepts, audit scope and statistical sampling methods, medical record audit abstraction, category risk analysis and communication.

This training is designed to target key training needed in a post-audit setting. Created by expert auditors for Providers to ensure understanding of key areas of evaluation and management coding, billing and documentation.

  • 95 Evaluation and Management Guidelines
  • 97 Evaluation and Management Guidelines
  • Common Office Procedures
  • Consultations
  • The History Component
  • Incident-to Services
  • The Medical Decision Making Component
  • Inpatient Coding
  • Modifiers
  • Nursing Facility Services
  • Preventive Medicine Services
  • Primary Care Services
  • ROS and PFSH Components
  • Teaching Physician Guidelines
  • Top Ten Common E/M Errors

Our auditing webinar series bring you the education you need from experts you know and trust--all at a great price. The best way to stay current in compliance, scratch the cost and inconvenience of the travel-- get the best value education now!

  • Auditing for PATH Guidelines
  • Risk Analysis vs. Forensic Auditing
  • How to Build a Good Audit Tool

Our auditing webinar series bring you the education you need from experts you know and trust--all at a great price. The best way to stay current in compliance, scratch the cost and inconvenience of the travel-- get the best value education now!

  • Understanding the Impact of ICD-10 on Medicare LCDs
  • Audit Scope, Sampling and Process
  • You've Been Asked to Do an Audit...Now What?
  • Surviving a Medicare Audit

Developing an effective audit plan can be a daunting task. Despite this, some medical practices still choose to assign these crucial responsibilities to someone whose plate is already overflowing. Organizations that jump into auditing without a defined plan might waste a lot of hard work, only to fail to move the organization forward. Luckily, there are a number of way to avoid unsustainable pitfalls that lead to a frustrated administration and fed-up providers.

Approximate Length: 1 hour

You will learn:

  • how to begin and what to prioritize
  • risk areas to avoid
  • the most effective processes

As scrutiny increases for claims submitted through Medicare or other commercial payers, healthcare organizations desperately need proactive solutions to determine which providers should be audited.

From improper modifier use to medical necessity, the risks are many. During this 30-minute presentation, we'll walk you through real-life examples of common coding errors, then demonstrate how using predictive analytics can save your organization from the fate of litigation and fines.

Approximate Length: 25 mins

Watch our on-demand demo webinar, Know Who to Audit and When, to learn how Analytics gives you the power to:

  • Identify Common Billing Trends
  • Uncover Outlier Patterns
  • Draw Provider Comparisons Between Peers

You’ve hired a rockstar coder to improve your bottom line. You’ve done your homework and found someone with knowledge, initiative, critical thinking skills and precise communication. Regardless of their excellent skills, how can you be sure that this amazing coder-who sat before you in an interview and wowed you with his or her experience and expertise-will increase your bottom line without increasing your risk to insurance carriers?

Every coder, no matter how experienced, will need help at some point to navigate the tricky and ever-changing terrain of the CPT book and payer policy. Purely from a business perspective, your practice needs to operate at its financial best so you can stay afloat and your providers can focus on enhancing patient care and outcomes. But how do you achieve this in your already busy week?

Approximate Length: 44 mins

Watch our on-demand webinar, Who's Auditing Your Coders? to learn how to:

  • Set Expectations for the Coder
  • Schedule a Baseline Review with an Experienced Auditor
  • Hire a Third-party Auditor

If you’re unclear about 99211, you’re not alone. A lot of debate surrounds the proper billing and documentation of E/M level service 99211 because aspects, like when to use it and when not to, can certainly be confusing.

Since the adoption of E/M codes, requirements for reporting most levels have become incredibly specific, and following these mostly black-and-white rules leads to an increasingly small margin of error in level selection.

Unsurprisingly, 99211 is one of our hottest topics this year. That’s why we’re offering even more E/M level service 99211 info, in-detail where we can elaborate on acceptable use even further.

Approximate Length: 1 hour 5 mins

Watch our on-demand webinar, An Expert's Tips and Best Practices for Using 99211, to learn:

  • Proper Documentation of Medical Necessity for 99211
  • When to Use 99211 and When Not to Use It
  • Clinical Examples That Both Supportand Do Not Support the Need for99211

Need help defining a “detailed” examination using 1995 Documentation Guidelines for Evaluation and Management Services? In the same amount of time that it will take you to eat a sandwich, I can help you decode “detailed.”

Where CMS has been reluctant to expand the definition, some of the MACs have provided additional instructions/clarifications that we can use to improve our understanding. Sometimes it takes a village to master an audit. Come join our tribe.

Approximate Length: 1 Hour

In this webinar, Autopsy of a Detailed Examination, you’ll learn how to:

  • Differentiate Between “Body Areas” and “Organ Systems”
  • Audit the Examination Portion of an E/M Service Observing MAC’s Guidance with 1995 DGs
  • Understand When (if) the 1997 Criteria May Better Fit Your Practice

The success of emergency medicine is defined by the ability to effectively complete critical interventions on patients who present systemic organ or life-threatening illnesses and/or injuries. Timely interventions have a direct impact on patient outcome.

Understanding critical care is paramount for the financial and compliance success of your organization. Physicians must strike a balance between overreaching in their coding and undervaluing their services. Coders need to be as informed as possible for the sake of their practice.

Get up to speed on critical care. Start by learning the definition of critical care and which services are considered critical care, such as Renal Failure, Hepatic Failure, Metabolic Failure, and more. Memorize what critical care documentation should look like and what “documentation failures,” to watch out for. For your organization to succeed, critical care has to be a team effort where everyone is on board.

Approximate Length: 1 hour 5 mins

Watch this on-demand webinar, "Providers and Critical Care: A Potentially Dangerous Love Story," to dive deeper into critical care and learn:

  • Definitions of Critical Care – It Makesa Difference
  • Documentation Tips and Tricks
  • Examples of Critical Care and Non-Critical Care with Case Examples

When implementing your compliance audit plan, you’ll probably get to a point where you’ll ask yourself whether you should outsource coding and documentation audits. Outsourcing can benefit every organization by improving the quality of your audit and supplementing your compliance program among many other things. But, before you choose to outsource, it’s important to learn how to evaluate an external audit company to ensure that you reap all the benefits.

Approximate Length: 52 mins

Watch this webinar on-demand and learn how leveraging the right external auditors can help you:

  • Save Time
  • Improve Internal Operations
  • Provide Validation to Your Codersand Physicians

Healthcare environments are prone to conflicts of interest because they’re a perfect example of a complex adaptive system (CAS). These systems are prone to error on a regular basis, but, lucky for us, they’re also capable of incredible innovation, if you create the right conditions.

Within healthcare, misunderstandings and conflicts usually involve several distinct parties and occur at multiple levels at the same time. It’s critical to define these potential conflicts, especially in relation to oversight in coding, billing, auditing, and compliance, so you can develop strategies for prevention and management.

Education is vital to effectively prevent and manage conflicts. Organizations are much less likely to have internal conflicts when they invest in the education and training of their employees.

Approximate Length: 55 mins

Watch this on-demand webinar, Auditing When There Are Conflicts of Interest, to learn how to:

  • Identify Conflicts in E/M Services
  • Avoid Conflicts Between Medical Necessity and Medical DecisionMaking
  • Reduce Conflicts Between Your Organization and External Consultants

Hiring an external auditor is an excellent way to ensure ideal operations within your organization. External auditors are not employees, therefore, they’re free of conflicts of interest. They’re often able to see problems that may otherwise go unnoticed. When you bring external auditors in to your organization, it’s not uncommon for the entire staff to think the worst. Perceptions of inadequacies, compliance problems, and bad business decisions swirl around the minds of employees who fear the loss of employment and/or a ruined reputation. Negativity and fear can lead to defensiveness and internal sabotage that can potentially destroy the entire process.

Set the tone within your organization when you hire an external auditor. Ease the minds of your staff members regarding the role of the audit by communicating wisely, and openly.

Approximate Length: 57 mins

Watch this on-demand webinar, Enhancing Your Audit Plan with an External Audit, to learn how to:

  • Why Hiring an External Auditor is Crucial for Your Organization?
  • How Internal and External Auditors Can Help Each Other
  • How to Set Expectations

The wildly successful RAC program was created by the CMS to identify and correct Medicare improper payments made on healthcare claims. Since its inception, millions of dollars in overpayments have been recovered from healthcare organizations. Preparedness is vital.

Understanding the areas where your organization is the most vulnerable will allow you to effectively minimize auditing risks. It’s essential to learn what policies, procedures, and action plans you should incorporate and which previous sample audit scenarios will enhance your compliance effectiveness.

Approximate Length: 52 mins

Watch this on-demand webinar to learn "10 Tips to Minimize Recovery Audit Contractor (RAC) and Other Audit Risk Exposure", including:

  • Pre-Audit Risk Assessment
  • Claims Data Analysis
  • Location-Focused Audit
  • Specialty-Focused Audit
  • Software Review
  • Follow-Up Action Plan

Each quarter of the fiscal year, the regional Medicare Administrative Contracts (MACs) perform Comprehensive Error Rate Testing (CERT) audits. The results provide important insight into the overall state of E/M coding and billing around the country for Medicare Part B claims.

A comprehensive understanding of these audit examples, as well as those conducted by the AAPC, will enable providers to focus their audit efforts for enhanced compliance and reimbursement within their own organization.

Our webinar, "The Five Problem Areas Evaluation & Management (E/M) Audits", will uncover common mistakes made within the areas of: history, examination, medical decision making (MDM), coding and data entry, and general documentation.

Approximate Length: 42 mins

Watch this on-demand webinar to learn "10 Tips to Minimize Recovery Audit Contractor (RAC) and Other Audit Risk Exposure", including:

  • Where to Avoid Areas of Risk inHistory, Exam, and MDM
  • How to Eliminate Documentation Errors for E/MAudits
  • What MACs Said Around E/MAudits for 2015

During this 60-minute on-demand webinar we'll provide a look at industry best practices and methodology for creating, implementing, and conducting physician evaluation and management (E/M) documentation and coding audits within your organization.

Approximate Length: 48 mins

Viewers will be presented with many best practices and tips on the following:

  • Setting up your audits
  • Leveraging audit resources
  • Reporting and education
  • Understanding common areasof risk