The AAPC is opening a new audit services division that will provide full-service health care compliance and corporate integrity audits. The new audit division will service outpatient practices, health plans, health care attorneys, and government regulators, to determine key areas of risk and provide detailed recommendations to resolve them. AAPC will use member auditors to provide services in all specialties and are leveraged from the credentialed AAPC members nationwide.

The AAPC will validate each audit, focusing on the areas of an organization that have the greatest risk potential. Auditors will provide the following services:

• Insurance Audit Appeals
• Coding and Billing Accuracy
• Accounts Receivable Audits
• Corporate Integrity Audits
• Compliance Audits
• Expert Witnesses
• ICD-10 Readiness

Learn more about the AAPC Audit Services Division.

21 Responses to “AAPC Adds Auditing Services”

1. Nancy M Ash-Heriegel, CPC Says:
   April 21st, 2010 at 12:51 pm

   I am very interested in becoming a certified auditor. Does the AAPC offer any courses? Once certified would the AAPC be looking to hire auditors for remote auditing? Thank-you Nancy M Ash-Heriegel, CPC

2. Sharon Hanson Says:
   April 21st, 2010 at 1:39 pm

   I too am Interested in becoming a Certified Auditor

3. Mary Maloy Says:
   April 21st, 2010 at 1:53 pm

   I do not see this as such a good thing. I think it is a conflict of interest on the part of AAPC. You are the one that certifies these auditors. Sounds a little fishy to me!!! Also for those of us who are in the consulting business this takes work away from us. You are a credentialing organization susposedly to provide guidance and support to your AAPC members. I see this as direct competition with only your interest at heart! I am opposed to AAPC being in the auditing business.

4. Sandra Woolard Says:
   April 21st, 2010 at 2:23 pm

   I also think this is a conflict of interest. You are setting up a competitive organization/service for the very members who provide your support.

5. CathyWeirick Says:
   April 21st, 2010 at 3:34 pm

   I agree with the comments opposing the AAPC entering the auditing business. Reminds me of when AAPC proposed to only allow CEUs for AAPC sponsored events. I think as a credentialing organization, the AAPC seems more focused on what is best for AAPC, rather than what is best or most beneficial for the membership. Another primary reason why so many people jumped ship to join other coding organizations.

6. Mark Hartmann Says:
   April 22nd, 2010 at 6:27 am

   This scheme presents both a conflict of interest and competition with its members. Let me explain: My firm audits medical bills for health plans and insurance carriers. Now, the organization I rely upon for valuable information and credentialing, is competing for the same business I am.

   AAPC: You can’t compete with your customers and expect them to be loyal to you for a very long period of time! If the AAPC continues down this path, I am not sure I can renew my membership next year or pay for the membership of my staffers either.

7. Amy Morgan, CPC Says:
   April 22nd, 2010 at 6:28 am

   I agree with Mary Maloy! This audit service is a conflict and does not bring value or support to the membership.

8. Melissa Brown CPC Says:
   April 22nd, 2010 at 7:33 am

   I agree that this is a conflict of interest. How does this service help us as paying members?

9. Pamela Pully CPC, CPMA Says:
   April 22nd, 2010 at 7:43 am

   Nancy you can receive training visit http://www.NAMAS-auditing.com. Times are changing and a CPMA certification is a great thing. I have been certified for more than two years and I was excited that the AAPC chose NAMAS and the CPMA to go with the CPC credentialing. So many EHR and EMR systems code for providers. Auditors are needed to check for accuracy. Having an auditing certification has only helped me. I now have additional credentials when applying for jobs and added knowledge. I think it is a great thing. Good for the AAPC keep us moveing forward.

10. Matthew King, CPC, CCS-P Says:
    April 22nd, 2010 at 8:27 am

    Agreed. I don’t appreciate competing with the AAPC.

    You don’t see the AMA running a primary care practice.

11. Lynn Berry Says:
    April 22nd, 2010 at 1:25 pm

    I agree with many of the writers. This is a conflict of interest on the part of the AAPC which brings great concern. Many of us own struggling small consulting businesses and don’t need another competitor that should not be in this business in the first place. I am happy that you are offering the auditor certification, though I believe the cost is too high. But to get into the actual auditing business in competition with your members is unthinkable to most of us.

12. Toree Harris Says:
    April 22nd, 2010 at 4:26 pm

    I also agree with the other members of the AAPC. You have been of great service to us in the past, but now your focus seems to be about profit margins versus support for future and current AAPC members.

13. Colleen Rexin Says:
    April 22nd, 2010 at 7:30 pm

    I agree with Cathy W. in that the new auditing credential and service will benefit the AAPC more than the members. Why not offer advocacy to members who are in need of this organization we support. Specifically, many of our members are and have been auditors for years, but yet when we are out there in the field sharing the knowledge we are often not taken seriously or worse. I know a business needs to produce revenue but this seems like more of the same from the AAPC. It would be nice to have the AAPC provide a value to the members instead of members having to continue to spend hard earned money to keep membership with little benefit professionally.

14. Reed Pew Says:
    April 23rd, 2010 at 11:25 am

    if you are interested in becoming a certified auditor, check out http://www.aapc.com/certification/cpma.aspx

15. Jennifer, MBA CPC,CPC-H Says:
    April 26th, 2010 at 6:22 am

    Unless you plan to hire US or outsource to US, then this is a clear conflicty of interest. If it becomes like the CPC-I where local companies get filtered to the local consultants, then I believe it would be viable.

    It would be tantamount to business cannabalism otherwise. This weakens the AAPC brand, and I do not suggest this action continues.

    Reed, you know better than this.

16. Christine Lee, CPC, RHIA Says:
    April 26th, 2010 at 9:55 am

    I too believe this is a direct conflict of interest. This type of activity will further weaken our credentials as something we “bought” rather than something we worked for an earned……..

17. CL Smith, CCS, CCS-P, CPC, PCS Says:
    April 26th, 2010 at 2:48 pm

    On the surface, this seems like a conflict of interest. I’m sure the AAPC looked into that before launching this new service. Maybe as we learn more about it, things will become much clearer.

18. Ann Starnes Says:
    April 29th, 2010 at 12:51 pm

    This is surprising as in the govt., military system all of the coders are audited. We were supposed to fight back if we realized we were correct. They were always nice to us, and there came in two different auditing systems.

19. Karen H, CPC, PCS Says:
    May 12th, 2010 at 7:25 am

    I am shocked that AAPC would start an “audit division”. This is clearly a move that conflicts with what AAPC was intended to be – a credentialing organization focusing on educating it’s membership. I would suggest all involved in this bad deicision review the “AAPC Code of Ethics” AAPC seems to be headed in the wrong direction.

20. Deb RN,CPC,CCS-P, PCS Says:
    May 12th, 2010 at 7:32 am

    What was the rational for starting this auditing division?
    I agree with the comments posted above about being a direct conflict of interest. It makes me question the leadership and direction AAPC seems to be taking.

21. Jin Zhou, President, ERISAclaim.com Says:
    September 20th, 2010 at 9:28 am

    FYI Only:

    Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act; Interim Final Rule [7/23/2010]

    Going into effect on Sep. 23, 2010

    [[Page 43352]]

    “(ix) The State process must provide that any approved IRO has no
    conflicts of interest that will influence its independence. Thus, the
    IRO may not own or control, or be owned or controlled by a health
    insurance issuer, a group health plan, the sponsor of a group health
    plan, a trade association of plans or issuers, or a trade association
    of health care providers. The State process must further provide that
    the IRO and the clinical reviewer assigned to conduct an external
    review may not have a material professional, familial, or financial
    conflict of interest with the issuer or plan that is the subject of the
    external review; the claimant (and any related parties to the claimant)
    whose treatment is the subject of the external review; any officer,
    director, or management employee of the issuer; the plan administrator,
    plan fiduciaries, or plan employees; the health care provider, the
    health care provider’s group, or practice association recommending the
    treatment that is subject to the external review; the facility at which
    the recommended treatment would be provided; or the developer or
    manufacturer of the principal drug, device, procedure, or other therapy
    being recommended.”

    http://www.dol.gov/federalregister/HtmlDisplay.aspx?DocId=24056&AgencyId=8&DocumentType=2

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