Certified Healthcare Auditor [CHA]

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1 Presents Certified Healthcare Auditor [CHA] Advanced Training & Certification Become a Certified Healthcare Auditor (CHA) A comprehensive distance learning course for providers, compliance officer and health care executives! AIHC 445 W. Liberty Street, Suite 214 Medina, Ohio Call toll free: (866)

2 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 experience working in management in the area of compliance or auditing of a health care organization. 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:

4 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: 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 14 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 . Course Tuition Cost: $2,100 Includes: Three (3) text books, training materials, one-on-one training, AIHC membership and certification exam: No refunds are available after lesson 1 is completed. The course must be completed within 9 months due to changing rules & regulations the certification exam needs to be timely after the course is completed, no more than 3 months after graduating from the training program. No discounts are given if student chooses not to take the certification exam. 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 for or 12 months.

5 Certification Exam Certification Exam is through The American Institute of Healthcare Compliance (AIHC): The certification exam is optional but the exam cost is included in your tuition. 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 and 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 $70 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 Text/Materials Supplied Through the Program (included in tuition) Reading assignments sent with each lesson by your instructor; Math Basics SparkChart; Managerial Skills Reference Guide; Internal Quality Auditing by Denis Provonovost The Internal Auditing Pocket Guide by J.R. Russell Monitoring & Auditing Practices for Effective Compliance, 2 nd Edition by HCCA

6 MODULE I Program Specifics (Subject to change) Lesson 1: Auditing for Quality Improvement (compliance review) 1.1 Learn how to locate national and local coverage determinations 1.2 Understand the anatomy of a NCD/LCD and documentation requirements of medical necessity 1.3 Know how to locate CMS bundling edits and audit for appropriate use of modifier Develop advanced ICD-9-CM coding guideline expertise needed for compliant reporting of medical necessity on the claim form Lesson 2: Fundamentals of Business System Auditing 2.2 Check lists 2.3 Do s and don ts of behavior 2.3 Conducting planning meetings appropriately 2.4 Auditing process of business systems. 2.5 Communications, Motivating People, and Managing Teams Lesson 3: Standards, Benchmarks, Goals & Objectives 3.1 Importance of setting your own facilities benchmarks and consistently meeting those benchmarks 3.2 How to measure progress against benchmarks 3.3 Internet research Lesson 4: Math, Reporting Graphic Illustrations 4.1 Math overview, formulas and math basics 4.2 How to determine the sample type & size for the audit 4.3 Data collection 4.4 Producing colorful illustrations of findings (charts, graphs) to report audit findings MODULE I EXAM - This is a proctored exam.

7 MODULE II Lesson 5: Statistics and Gap Analysis 5.1 Understand and perform statistical analysis of data 5.2 Conduct a gap analysis and analyze results for reporting purposes 5.3 Managing Time, Making Decisions Lesson 6: Delegating, Negotiating & Managing Change 6.1 Skills of delegation 6.2 Negotiating appropriately 6.3 Managing change resulting from your audits will be learned 6.4 Management styles, effective management of audit teams Lesson 7: The Audit Process 7.1 Reviewing a mock audit 7.2 Calculating statistical analysis of mock audit findings 7.3. Comparative analysis of baseline audit to follow up audit Lesson 8: Understanding the Medical Record & Patient Privacy 8.1 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. 8.2 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 - This is a proctored exam. MODULE III Lesson 9: Auditing Standards and ASQ Understand accepted national and international standards in measuring quality and in auditing. 9.2 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 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 & Implementation Methods 11.1 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.

8 Lesson 12: Implementation of the Auditing Team & Organizational Change 12.1 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 Compliance MODULE III EXAM - This is a proctored exam. MODULE IV This module is designed to focus on advanced auditing skills related to prevention of fraud and abusive billing practices. Joanne Byron has over 35 years of health care experience and teaches Module IV to all students to prepare them for graduation and the certification exam. Other instructors may be assigned to teach students Modules I-III. Lesson 13: Audit Competency 13.1 Comprehensive coding competency assignment. This lesson includes exercises to provide feedback to students regarding coding expertise and understanding of coding guidelines. This lesson is designed for professional coders, but also for compliance managers and providers. Lesson 14: Voluntary Vs. Mandatory Compliance, Monitoring & Auditing 14.1 Voluntary Disclosure & Refund, RACs, CIA and agreement negotiations, Preparing for Independent Review Organization Lesson 15: Report Preparation Audit assignment 15.1 This Lesson provides guidance to the student through an actual auditing process which will be performed within his/her own facility. The assignment is customized according to the type of facility and audit to be conducted.

9 Certification Exam (optional) Becoming a Certified Healthcare Auditor Many students take the course only, without intent of becoming certified. Tuition includes AIHC membership and the $250 exam fee. The certification exam is offered to those qualifying to become certification healthcare auditors. Certification from ACMCS, AAPC and/or AHIMA with 5 years or more coding experience may qualify to take the exam. A physician or non-physician provider, nurse auditors or experienced compliance officers required to audit business practices and systems may qualify to take the certification exam. Those wanting to take the Exam Only cost is: Annual AIHC membership fee, $250 exam fee. We strongly suggest purchasing the course text books to use as study guides in preparation for the exam. The Certification Exam is approved by the American Institute of Healthcare Compliance Certification Exam Board. The Exam Administration Process is overseen by our Board of Directors.

10 CHA Distance Learning Program Registration/Enrollment Form Call with any questions about registration, the course or certification exam. $2,100 Certified Healthcare Auditor Course, Certification Exam & AIHC membership FILL OUT MEMBERSHIP APPLICATION AND SUBMIT WITH COURSE REGISTRATION SEE BELOW Date of Enrollment Amount Due All Inclusive Fee: $2,100 Print Name, Position, Current Credentials & Check Highest Level of Education Employer & Address High School Associate s Degree Diploma Program Bachelor s Degree Master s or Higher Address (required for confirmation of enrollment) Work Phone/Ext. Fax Home Phone Charge My Credit Card: [ ] VISA [ ] MasterCard [ ] Discover [ ] American Express Card #: Security code (3 digits on back of card): Exp. Date: Name as it appears on the card: Authorized Signature & Date: CHECK #: AMOUNT ENCLOSED $ Please make checks payable to: AIHC; Mail to American Institute of Healthcare Compliance 445 W. Liberty Street, Suite 214 Medina, OH Fax: If you have any questions, or to register by telephone with a credit card, please call Please visit our website at for more information about our company. Inquiries should be made to

11 Job/Position (title & brief description): Are you certified by any organization? Please indicate certification and company name: Are you a licensed clinical professional? Please check all appropriate boxes: MD/DO Physician Assistant Chiropractor Nurse Practitioner/Midwife Doctor of Podiatric Medicine Registered Nurse Physical Therapist Licensed Practical Nurse Occupational Therapist Medical Assistant Speech-Language Pathologist Other Kinesiotherapist OIG exclusion Have you ever been? 1) Notified that you were under investigation for; investigated for; charged with; or convicted of any offense relating to Medicaid or Medicare fraud? 2) Have you ever been on the OIG exclusion list? Membership Requirement (Restriction) AIHC membership is open to the public, health care workers and administrators as well as certified healthcare auditors, collectors and compliance officers. To uphold to a higher standard, AIHC follows the guidelines recommended by the Office of the Inspector General (OIG) regarding retention of excluded individuals. For many years the Congress of the United States has worked diligently to protect the health and welfare of the nation's elderly and poor by implementing legislation to prevent certain individuals and businesses from participating in Federally-funded health care programs. The OIG, under this Congressional mandate, established a program to exclude individuals and entities affected by these various legal authorities, contained in sections 1128 and 1156 of the Social Security Act, and maintains a list of all currently excluded parties called the List of Excluded Individuals/Entities. (See OIG website at No individual whose name appears on the OIG Excluded Individuals Entities List may hold membership in AHIC; and any member whose name is added to this list will have his/her membership status revoked without refund. My signature below indicates I have read this restriction to membership and attest that I am not currently on the OIG exclusion list at the date this application has been submitted for membership to the American Institute of Healthcare Compliance. Signature Date

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