Le ad Audito r Train in g & Certification Program

Transcription

1 Presents Le ad Audito r Train in g & Certification Program Become a Certified Healthcare Auditor (CHA) A comprehensive distance learning course for auditing managers in healthcare! AIHC PO Box 572 Medina, Ohio Call toll free: (866) (Visit our web site which is still under construction!)

2 Lead Auditor Training for Certification A Distance Learning Program Level Prerequisite Advanced coders, certified coders, nurses and/or other licensed health care professionals with responsibility for compliance and/or auditing. Enrollees should be presently working in a health care facility in Quality Assurance, Compliance, Coding, Billing or related area. Enrollees must have a sound working knowledge of medical terminology, anatomy and coding expertise. CEUs The AAPC has pre-approved 24 CEUs for successful completion of this course. CEUs are renewed by AAPC each February This program is a distance learning program requiring self discipline for study and research time, as if you were attending class. A grade average of 80% for the entire course is required to pass and earn the certificate of completion. Type Computer Specifications: Distance Learning, Self-directed work program with a certified instructor. Internet access (for research projects); Microsoft Word, Excel, Learning Objectives Critical areas of audit compliance as mandated by CMS and the OIG; To research Internet resources to keep abreast of audit compliance changes; How to lead an auditing team, assess leadership skills and improve communication; Basic math review, introduction to statistical analysis and sampling methods, comparative analysis and formulas to use to adequately report findings; Essentials of HIPAA, patient privacy and the auditing process; National standards for auditing as established by the American Society for Quality (ASQ); How to perform a gap analysis; and Create auditing forms to use in the auditing process to increase speed and accuracy.

3 Overview of Program Standards Used to Develop Program - the American Society for Quality (ASQ) is the world s leading authority on quality since By making quality a global priority, an organizational imperative, and a personal ethic, ASQ becomes the community for everyone who seeks technology, concepts, or tools to improve themselves and their world. ASQ makes its officers and member experts available to inform and advise the U.S. Congress, government agencies, state legislatures, and other groups and individuals on quality-related topics. ASQ representatives have provided testimony on issues such as training, healthcare quality, education, transportation safety, quality management in the federal government, licensing for quality professionals, and more. ASQ also works with the media on quality-related matters, providing informational resources and referrals to qualified experts from its broad member base. Web Site: The Office of the Inspector General (OIG) provides guidance regarding auditing and monitoring expectations for compliance to Federal health care programs. Students are assigned specific learning tasks related to the eight Compliance Guidances provided by the OIG directly relating to high risk areas for auditing. Web Site: The Centers for Medicare & Medicaid (CMS) provides learning tools on the national web site: Specific research assignments are offered to sharpen resource skills of students in areas of CMS compliance, coding, documentation, medical necessity, National Coverage Determinations and Local Coverage Determinations (local medical review policies) in addition to CCI edit issues, 1995 and 1997 E&M documentation and coding guidelines are used in training. The American Health Information Management Association (AHIMA) information is researched by students to increase resource skills throughout the program regarding documentation standards in medical records. Web Site: The Medical Group Management Association (MGMA) publishes articles and journals applicable to benchmarking, auditing and quality. Students access information from the MGMA during the program. Web Site:

4 Program Structure Each Lesson begins on Monday and homework is due for most lessons the following Monday. Some lessons are two weeks due to the large reading and/or homework assignments. Additional homework or assignments may be given to ensure comprehension of the material. Additional assignments are ed or faxed by your instructor. The program consists of 10 lessons. Instructors will contact students as necessary and when a student s average grade falls below 80%. Instructors are also available for questions Monday-Friday via phone or . Tuition $2,000 Tuition for AIHC members which includes: 15 lessons divided into four (4) Modules, Module Exams to prepare you for the Certification Exam, four (4) text books and a qualified instructor to coach you during the course. AIHC member who are also certified coders through AAPC, ACMCS and AHIMA may be eligible for a 10% ($200) discount on tuition. Call regarding this discount. $2,100 Tuition for non members. No discounts apply. Financial Assistance & Scholarship Opportunity AIHC offers scholarship assistance to those individuals working for a company not offering tuition reimbursement or only offering tuition reimbursement for college accredited courses (which this course is not). For others, we offer 4.99% financing on our payment plan options. A down payment of $500 is required to qualify for financing the balance.

5 Certification Exam Cost (separate from course tuition) $250 Certification Exam through The American Institute of Healthcare Compliance (AIHC): The certification exam is optional. Testing is arranged directly through AIHC. Method of testing: On-site testing at your office with a pre-approved proctor or web-based testing. 100 Questions covering Quality Management, Coding Compliance & Leadership) requiring 80% score to pass. Exams can be retaken within 6 months from the end of completing the program up to three times at no additional cost. Annual Certification Renewal Certification Renewal is Annual for only $65 a year and provides membership to The American Institute of Healthcare Compliance! Renewal fees are managed through the American Institute of Healthcare Compliance and subject to change. 4 CEUs- Quality Management (i.e. statistics, quality improvement, quality control, quality assurance, leadership and/or management) 4 CEUs- Compliance (i.e. HIPAA, OIG, CMS, billing, coding, auditing) Course Books Course Text/Materials Supplied by Student (coding books) Current CPT book, AMA Professional Edition; Current ICD-9-CM Volume I & II or Volumes I, II & III (for hospitals); Current HCPCS Level II Text/Materials Supplied Through the Program (included in tuition) Reading assignments sent with each lesson; Math Basics SparkChart; American Society for Quality Approved Text for Auditing; The Internal Auditing Pocket Guide

6 MODULE I Program Specifics (Subject to change) Lesson 1: Auditing for Quality Improvement Objective: to inform students of differences between auditing and monitoring, why auditing and monitoring are necessary in health care facilities, compliance issues and the OIG. Students will learn the anatomy of an LMRP and NCD, how to use them for compliance auditing and determining medical necessity, CCI edits and outpatient bundling requirements and unique aspects of compliance specific to therapy. Internet resources are given along with homework assignments involving the Internet and researching topics specific to the student s specialty and/or facility type. Basic math review. Lesson 2: Fundamentals of Business System Auditing Auditor training is provided in Lesson 2 addressing check lists, do s and don ts of behavior, conducting planning meetings appropriately. How to perform a Gap Analysis for compliance is included. Forms are provided on disk for student use in the work place. A practical approach is taken to learning the overall auditing process and quality standards expectations of the OIG. Essential Manager s Manual assignments: Communicating Clearly, Managing Meetings, Motivating People, Managing Teams. Basic math review. Lesson 3: Standards, Benchmarks & Goals & Objectives This Lesson instructs the students regarding specifics on SOPs to be developed as a result of the audit. The importance of setting your own facilities benchmarks and consistently meeting those benchmarks is emphasized along with exercises on how to measure progress against those benchmarks. Setting focused goals and objectives, contingent upon the type of audit being performed is addressed. Reading assignments are involved with some Internet research. Basic math review. Lesson 4: Math, Statistics, Reporting Graphic Illustrations This Lesson will provide: 1) math overview, formulas and math basics 2) training on how to determine the sample type & size for the audit 3) data collection (in Excel or Access), producing colorful illustrations of findings (charts, graphs) to use in your Report of Findings and Corrective Action Plan. MODULE I EXAM MODULE II Lesson 5: Auditing SOP (Standard Operating Procedures) This Lesson teaches through hands-on experience. Students are required to: 1) research all applicable policies and procedures currently written and implemented in their facility (data collection) 2) how to use this data to compare to where it needs to be for compliance (performing a Gap Analysis) and 3) how to report the findings of the Gap Analysis. Essential Manager s Manual assignments: Managing Time, Making Decision.

7 Lesson 6: Delegating, Negotiating & Managing Change Leadership skills are critical to the success of a lead auditor. The skills of delegation, negotiating appropriately and managing change resulting from your audits will be learned. Essential Manager s Manual reading assignments. Lesson 7: The Audit Process This Lesson takes the student through a mock audit: 1) A policy & procedure will be provided along with 2) information to determine the type of audit to perform 3) enough data supplied so the student can establish the sample size 4) the student will develop a Report of Findings and Executive Summary 5) the report will require graphic illustrations. Lesson 8: Understanding the Medical Record & Patient Privacy Training is provided covering documentation standards in the health care industry, appropriate correction of errors, how health care records, including EMR (electronic medical records) are required to stand alone as legal documents. Elements of necessary documentation for various facilities will be addressed. HIPAA and patient privacy is emphasized in relation to responsibility of the auditor to maintain confidentiality during the auditing process. MODULE II EXAM MODULE III Lesson 9: Auditing Standards and ASQ 1 Auditors in health care must learn accepted national and international standards in measuring quality and in auditing. The American Society for Quality text will be used to provide background in auditing standards, statistics required for best outcomes measurements and a historical perspective of ASQ. Lesson 10: Auditing Standards and ASQ 1 Lesson 9 continues into lesson 10 where the student continues to learn about project management, managing and auditing team and internet research projects to enhance knowledge of national and international standards in auditing. Lesson 11: Auditing Processes, Stress Management & Implementation Methods The program continues developing the student s awareness of acceptable standards in auditing to include recommended processes, managing stress which comes with responsibility and accountability of auditing and implementation methods of a large auditing program. Lesson 12: Implementation of the Auditing Team & Organizational Change Students learn more regarding how to train, teach, and be instrumental leaders in the organization to implement the auditing team. Organizational behavior, effects of change on physicians, administration and staff are learned through reading assignments and internet research projects. MODULE III EXAM

8 MODULE IV Lesson 13: Coding Skills This lesson is an opportunity to show your instructor your superior coding skills! comprehensive lesson with over 200 coding questions! A Lesson 14: Performing an Audit This Lesson provides guidance to the student through an actual auditing process which will be performed within his/her own facility. This includes: 1) performing a Gap Analysis 2) reporting results of the Gap Analysis 3) selecting the type of audit to perform 4) determining sample size 5) performing the audit utilizing auditing forms created from lesson 14 6) drafting a Report of Findings & Executive Summary 7) graphic illustrations of findings 8) drafting a Corrective Action Plan 9) recommending a comprehensive monitoring procedure. Certification Exam (optional) Becoming a Certified Healthcare Auditor The certification exam is offered to those qualifying to become certification healthcare auditors. Certification from ACMCS, AAPC and/or AHIMA (apprentice and CCA certified individuals will not qualify) with 5 years or more coding experience may qualify to take the exam. The Certification Exam is approved by the American Institute of Healthcare Compliance Certification Board. The cost to take the certification exam is $250.

9 Staff & Administration Joanne Byron, LPN, BSNH, CPC, PCS, MCMC, CMC Joanne had designed courses for community colleges and hospital in areas of coding, auditing and practice management certification. Joanne is a nationally recognized professional speaker and trainer in the medical industry. As a consultant, Joanne specializes in staff training, reengineering and increasing efficiency, revenue enhancement, coding and reimbursement, compliance (OSHA, OIG, and HIPAA), Managed Care, Policies and Procedures (clinical and business), protocols, outcomes analysis, performance standards and human resources. She is a licensed nurse, has a Bachelor of Science degree from Clayton College and is a Certified Instructor (PMCC) with the American Academy of Professional Coders (AAPC). Joanne s professional affiliations are: American College of Medical Coding Specialists, Medical Group Management Association (MGMA), American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), American Association of Medical Assistants (AAMA) and American Society for Quality (ASQ). Robert (Bob) Pattison, CQM, CQA, CQE Certified Quality Auditor Robert (Bob) Pattison is a Certified Quality Manager (CQM), Certified Quality Engineer (CQE), and Certified Quality Auditor (CQA) with approximately 20 years of experience in quality and business systems management and implementation. He is an expert in ISO9001: 2000 and TE9000 standards (telecommunications) as well as the QS9000 standards of excellence. Bob provides advice regarding statistical evaluation of business operations, development of quality improvement systems, documentation, policies and procedures, staff training and education in quality improvement and serves as the quality expert for a practice management consulting firm.

10 Lead Auditor Certification Program Registration/Enrollment Form Call with any questions about registration, the course or certification exam. $2,000 (AIHC member) $2,100 (non member) Date of Enrollment Amount Due Print Name & CCS, CPC, PCS or other coding credentials (required Employer & Address High School Associate s Degree Diploma Program Bachelor s Degree Master s or Higher Home Address Address Work Phone/Ext. Fax Home Phone Charge My Credit Card: [ ] VISA [ ] MasterCard [ ] Discover Card #: (3 digit Security Code) Expiration Date: Name as it appears on the card: Authorized Signature & Date: CHECK #: AMOUNT ENCLOSED $ Please make checks payable to: AIHC PO Box 572, Medina, Ohio If you have any questions, or to register by telephone with a credit card, please call or