PMPC Designation case studies
PMPC Designation · Put your knowledge to work in context.
The Certified Medical Compliance Officer (CMCO) is a professional credential offered through the Practice Management Institute (pmiMD.com) for medical office personnel who build, run, and defend a practice's compliance program. It suits compliance officers, practice managers, billers and coders, auditors, and clinicians who own regulatory risk in an outpatient setting. The PMPC Designation case studies are 5 cases and about 2,401 words.
1The Physician Whose Name Appears on a Supplier's Claims
A 12-provider orthopedic group learns that one of its surgeons, Dr. Reyes, is listed as an ordering physician on 38 power-mobility claims submitted by a durable medical equipment supplier over 14 months.
495 words, about 2 min2The Modifier That Doubled the Payment
A 9-physician multispecialty clinic reviews 40 randomly selected charts for a payer audit readiness exercise. In 6 of them, the same practitioner billed an evaluation and management visit and a minor procedure on the same day, appending modifier 25 to the E&M code.
473 words, about 2 min3When the Compliance Officer Reports to the CFO Under Investigation
A 200-bed community hospital's compliance officer, hired 11 months ago, reports directly to the CFO. The CFO also chairs the compliance committee and signs off on the compliance work plan.
474 words, about 2 min4The Excluded Biller in the Back Office
A home health agency's monthly exclusion screening is run by the billing manager against the OIG LEIE only, using a spreadsheet of employee names and dates of birth. In March, an internal tip alleges that a billing specialist, hired 19 months ago, was excluded in a prior state for a healthcare fraud conviction.
487 words, about 2 min5The Screening Vendor's False Negative
A 60-provider physician network outsources exclusion and sanction screening to a vendor that matches against the LEIE and SAM monthly. The contract states the vendor will match on name plus at least one secondary identifier and will report any hit within 24 hours.
472 words, about 2 min