Certifications

Certified Coding Specialist (CCS®)

The Certified Coding Specialist certification is designed for individuals skilled in classifying medical data from medical records. CCS professionals demonstrate a practitioner’s tested skills in data quality and accuracy as well as mastery of coding proficiency.

International Certification Preparation Training on

Domain 1 – Coding Knowledge and Skills (39-41%)

It is recommended, not required, to have at least one of the following:

• Complete courses in all the following topics: anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic coding, and procedural coding and medical services (CPT/HCPCS) plus one (1) year of coding experience directly applying codes; OR

• Minimum of two (2) years of related coding experience directly applying codes; OR

• Hold the CCA® credential plus one (1) year of coding experience directly applying codes; OR

• Hold a coding credential from another certifying organization plus one (1) year of coding experience directly applying codes; OR

• Hold a CCS-P®, RHIT®, or RHIA® credential

Prepare for the exam

Required Code Books:

1. Assign diagnosis and procedure codes based on the provider’s documentation in the health record

2. Identify principal/first-listed diagnosis and procedure based on the respective guidelines

3. Apply coding conventions/guidelines and regulatory guidance

4. Attach CPT/HCPCS modifiers to outpatient procedures

5. Determine appropriate sequencing of diagnoses and procedure codes based on the case scenario

6. Apply present on admission (POA) guidelines

7. Demonstrate knowledge of coding edits (e.g., NCCI, Medical Necessity)

8. Demonstrate knowledge of reimbursement methodologies (e.g., DRG, APC)

9. Abstract applicable data from the health record

10. Identify major co-morbid conditions (MCC) and co-morbid conditions (CC)

1. CPT® Professional Edition code book (current year), AMA publisher

2. ICD-10-CM code book (current year), any publisher

3. HCPCS Level II code book (current year), any publisher

Domain 2 – Coding Documentation (18-22%)

1. Resolve conflicting documentation in the health record (e.g., admission type, laterality)

2. Ensure all required documentation for assigning a specified code is available within the body of the health record

3. Verify and validate documentation within the health record

Domain 3 – Provider Queries (9-11%)

1. Resolve conflicting documentation in the health record (e.g., admission type, laterality)

2. Ensure all required documentation for assigning a specified code is available within the body of the health record

3. Verify and validate documentation within the health record

Domain 4 – Regulatory Compliance (18-22%)

1.Ensure completeness and accuracy of health records

2. Understand payer-specific guidelines

3. Identify patient safety indicators (PSIs) and hospital-acquired conditions (HACs) based on the provider’s documentation

4. Ensure compliance with HIPAA guidelines

5. Ensure adherence to AHIMA Standards of Ethical Coding

6. Ensure compliance with the Uniform Hospital Discharge Data Set (UHDDS)

Domain 5 – Information Technologies (9-11%)

1.Distinguish various types of Electronic Health Records (EHR)

2. Demonstrate a basic understanding of encoding and grouper software

3. IExhibit an understanding of computer-assisted coding (CAC) software and its impact on coding

4. Ensure compliance with HITECH guidelines

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Certified Professional Medical Auditor (CPMA)® certification

CPMA designed for the seasoned medical coding professional, the CPMA Training Course covers medical record standards and documentation guidelines, coding and documentation compliance, coding and reimbursement concepts, audit scope and statistical sampling methods, medical record audit abstraction, and category risk analysis and communication.

International Certification Preparation Training on

• Explain the impact of the OIG Work Plan and Corporate Integrity Agreements (CIAs)

• List the elements of compliance plans and identify potential compliance risk areas

• Identify National Correct Coding Initiative (NCCI) and Medically Unlikely Edit (MUE) risk areas

• Identify the purpose of recovery audit contractors and how to prepare for potential RAC audits · Explain the HIPAA privacy rule, including details on protected health information, minimum necessary, sharing of information, and enforcement

• Identify medical record documentation standards and record retention standards

• Identify common errors found in documentation for evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, and medicine services

• Explain the types of audits and the resources required for audits

• Define steps of the audit process and identify statistical sampling types and factors

• Provide practical application of auditing operative reports and evaluation and management services

Course Objective:

Compliance and Regulatory Guidelines including:

• Fraud and abuse

• Federal False Claims Act

• Anti-Kickback Law

• Stark Law

• Exclusion Statute

• Civil Monetary Penalties Law

• Office of Inspector General (OIG)

• Centers for Medicare and Medicaid Services (CMS)

• Medical Record Documentation Standards

  • HIPAA Privacy Regulations

  • Types and components of medical records

  • Accreditation standards

  • Evaluation and Management Coding

  • Coding and Reimbursement Concepts

  • CPT® Guidelines

  • Evaluation and Management

  • Anesthesia

  • Surgery

  • Radiology

  • Pathology and Laboratory

  • Medicine including chemotherapy, psychotherapy, physical therapy

  • Modifiers o Diagnosis coding and medical necessity

  • Physicians at Teaching Hospital (PATH) Guidelines

  • Auditing

  • Auditing process

  • Statistical sampling, utilization review, RAT-STATs

  • Risk Analysis and Communication

  • Validation of audit results

  • Analysis and report of audit findings

  • Communicating audit results

  • Practical Expertise

  • Practical audit skills utilizing cases for practical application

Methods of Evaluation:

Successful course completion includes:

• An attempt of all required assignments

• A passing score of 70% or higher on all chapter exams

• A passing score of 70% or higher on the final exam

• An overall final course score of 70% or higher No reduced hours in the course or tuition discount for previous education or training will be granted.

Required Code Books:

1. CPT® Professional Edition code book (current year), AMA publisher

2. ICD-10-CM code book (current year), any publisher

3. HCPCS Level II code book (current year), any publisher

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Course Content: