Certified Professional Healthcare Compliance Officer

As the healthcare field continues to expand, compliance requirements of various governments and regulatory agencies will continue to grow as well. All medical practices, no matter how big or small, will require a professional on staff who can organize, develop, manage and direct all compliance requirements. Moreover, mandatory compliance programs will become a condition of Federal healthcare programs in order to combat pervasive Medicare and Medicaid fraud and abuse as dictated by the Patient Protection and Affordable Care Act passed in 2010. To meet these needs, Certified Professional Healthcare Compliance Officers will increasingly be in high demand for the medical community. This certification from the American Academy of Professional Coders (AAPC) offers students the chance to gain nationally-recognized credentials in professional Healthcare compliance. In completing this course, participants will gain a comprehensive understanding of the key requirements needed to effectively develop, implement and monitor a healthcare compliance program for any practice in accordance with all regulatory requirements including internal compliance reviews, audits and risk assessments and as well as internal staff education and training in compliance requirements.

The Certified Professional Healthcare Compliance Officer course prepares learners to become certified Healthcare Compliance Officers. Learners will develop an understanding of the key requirements needed to effectively develop, implement, and monitor a healthcare compliance program for their practices or help others in their compliance efforts, which are based on governmental regulatory guidelines. Learners will emerge from this course fully prepared to sit for the AAPC’s Certified Professional Compliance Officer (CPCO) certification exam. The CPCO exam is recommended for individuals who have experience working in a compliance role, is extremely familiar with the key elements required for compliance programs as well as the regular operational aspects of compliance programs. Individuals should also be very familiar with the key laws and regulations impacting compliance programs, physician practices, and those used to address potential fraud and abuse, including the relevant penalties and fines. Individuals should also know where to go and how to research information to identify best practices to mitigate any compliance risks.

Class Objectives

After completing this class, learners will be able to:

• Demonstrate understanding of the OIG Compliance Guidance for Individual and Small Group Physician Practices, Clinical Laboratories, and Third Party Billing Companies
• Demonstrate knowledge of compliance program effectiveness techniques
• Demonstrate understanding of key healthcare fraud and abuse laws, including the False Claims Act, Stark Laws, and Anti-Kickback Statute, including the associated penalties
• Demonstrate understanding of how the PPACA will affect medical practices
• Demonstrate knowledge of other laws and regulations, including HIPAA, EMTALA, and CLIA
• Demonstrate understanding of how to handle investigations, including self-disclosure protocols
• Demonstrate knowledge of requirements under Corporate Integrity Agreements (CIAs) and Certificate of Compliance Agreements (CCAs)
• Demonstrate understanding of current investigative activities (RACs, ZPICs, MFCUs)
• Demonstrate understanding of various risk areas, including items such as gifts/gratuities, conflicts of interest, use of Advance Beneficiary Notices, teaching physician’s guidelines, and incident to services