In this section, we'll cover key laws and agencies related to healthcare fraud and abuse. The Federal False Claims Act targets fraudulent claims, while the Anti-Kickback Law and Stark Law aim to prevent improper financial relationships. The Exclusion Statute allows for the exclusion of individuals or entities from federal healthcare programs. The Civil Monetary Penalties Law imposes penalties for fraudulent activities. Oversight is provided by the Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS). Understanding these laws and agencies is crucial for maintaining compliance and ethical healthcare practices.

In this section, we'll cover essential aspects of healthcare information management. We'll discuss the HIPAA Privacy Regulations, which protect patient health information. We'll also explore the types and components of medical records, including their organization and content. Additionally, we'll touch on Accreditation Standards, which ensure healthcare organizations meet quality and safety requirements. Understanding these concepts is crucial for maintaining compliance and delivering high-quality care.

In this section, we'll explore key aspects of Current Procedural Terminology (CPT®) coding. We'll discuss the CPT® Guidelines, which provide instructions for accurate code selection. We'll also cover various sections of the CPT® manual, including Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine, which includes chemotherapy, psychotherapy, and physical therapy codes. Additionally, we'll discuss modifiers, which are used to indicate specific circumstances that affect code reimbursement. We'll also touch on diagnosis coding and medical necessity criteria, as well as the Physicians at Teaching Hospital (PATH) Guidelines for auditing coding practices. Understanding these concepts is essential for accurate and compliant coding practices.

In this section, we'll cover auditing in healthcare, focusing on methods like statistical sampling and utilization review. These techniques ensure compliance with regulations and guidelines in medical coding and billing. RAT-STATs is a specific method for identifying and recovering improper Medicare payments. Understanding these auditing methods is essential for maintaining accuracy and compliance in healthcare practices.

In this section, we'll cover validating, analyzing, and communicating audit results in healthcare. Validation ensures audits follow guidelines. Analysis identifies trends for improvement. Communication shares findings with stakeholders for action. Understanding these steps improves healthcare quality and compliance.

In this section, we'll focus on practical audit skills and their application in real-world scenarios. Using cases for practical application enhances these skills by providing hands-on experience in auditing. This approach allows professionals to practice identifying issues, analyzing data, and making recommendations based on audit findings. Through case-based learning, auditing professionals can improve their ability to conduct thorough and effective audits, ensuring compliance with regulations and identifying areas for improvement in healthcare practices.

Upon successful completion of the course and passing the final exam, you will receive a certification.