Maricopa Community Colleges  HSE202   20032-99999 
Official Course Description: MCCCD Approval: 11/26/02
HSE202 20032-99999 LEC 2 Credit(s) 2 Period(s)
Advanced Medical Service Auditing
Advanced CPT-4 E&M and service procedure coding. Examination and comparison of 1995 and 1997 documentation guidelines. Audit descriptions for components of medical service coding. Full-detail and summary audit data information and translation of audit data into summary reports. Compliance, fraud and abuse issues. Audit applications. Prerequisites: Completion of an approved advanced medical coding course or Certified Professional Coder, or permission of instructor.
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MCCCD Official Course Competencies:
 
HSE202   20032-99999 Advanced Medical Service Auditing
1. Compare and contrast the 1995 and 1997 CPT-4 documentation guidelines and their relationship to E&M coding. (I)
2. Describe the manual audit and software audit processes. (I)
3. Utilize audit software to develop summary reports. (I)
4. Provide audit descriptions for the "elements", "history", "exam" and "medical decision making" components of E&M service coding. (II)
5. Review and track service/procedure coding per report. (III)
6. Translate audit data into a format for full-detail and summary reports. (III)
7. Identify compliance, fraud and abuse issues. (III)
8. List strategies for resolution of traditional auditing problems. (III)
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MCCCD Official Course Outline:
 
HSE202   20032-99999 Advanced Medical Service Auditing
    I. CPT-4 E&M Coding Management
        A. Documentation Guidelines
          1. 1995
          2. 1997
        B. Audit Process
          1. Manual
          2. Software
            a. Applications
            b. Summary reports
      II. CPT-4 E&M Coding Utilization
          A. E&M Service Coding Components
            1. Elements
            2. History
            3. Time
            4. Exam
            5. Medical Decision Making
          B. Audit Descriptions of E&M Service Coding Components
        III. Audit Parameters
            A. Audit Full-Detail and Summary Reports
            B. Compliance, Fraud and Abuse Concerns
            C. Common Auditing Challenges and Resolution Strategies
            D. Audit Applications and Case Studies
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