Terminology

  • What is a CPC®?
  • What is an AHFI®?
  • What is a CCS®?
  • What is a Clinical Investigator?
  • What is a CLNC?
  • What is a CHCAF?

The Certified Professional Coder (CPC®) credential is the gold standard for medical coding in physician office settings. CPCs have demonstrated expertise in reviewing and assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers in the office or facility setting (eg, inpatient hospital) and a sound knowledge of medical coding guidelines and regulations including compliance and reimbursement – allowing a CPC to better handle issues such as medical necessity, claims denials, bundling issues, and charge capture. Learn more about the CPC.

An Accredited Health Care Fraud Investigator (AHFI®) is a unique professional designation granted by the National Health Care Anti-Fraud Association to individuals who have professional experience, specialized training, formal education and demonstrated knowledge in the detection, investigation and/or prosecution of health care fraud. Learn more about the AHFI.

A Certified Coding Specialist (CCS) is skilled in classifying medical data from patient records, generally in a hospital setting. A CCS review patients’ records and assign numeric codes for each diagnosis and procedure, possess expertise in the ICD-10-CM and CPT coding systems, and are knowledgeable about medical terminology, disease processes, and pharmacology. Learn more about the CCS.

Sometimes providers cover-up the errors in a medical record. Either a hospital, doctor, nurse, or other employee who was working on a patient or working with the medical record may cover-up or hide documents, medication errors, or they may replace medical records to avoid taking responsibility for mistakes. In some cases, the complex electronic systems may be adding erroneous, or incorrect information to patient records or medical claims. A nurse investigator possesses training and experience to recognize medical record tampering, negligence and fraud in medical records and claims data.

A Certified Legal Nurse Consultant is a registered nurse who has successfully mastered the rigorous CLNC® Certification Program and consults with attorneys on medical-related cases. The CLNC® consultant has the expertise to quickly pinpoint and interpret medical and nursing issues in any case involving health, illness or injury.  The CLNC® is a member of the NACLNC®. Learn more about the National Association of Certified Legal Nurse Consultants (NACLNC®).

A Certified Healthcare Chart Auditor – Facility is an auditor who has demonstrated expertise in auditing healthcare facility medical records. These expert auditors are competent in inpatient and outpatient coding as well understanding concepts such as statistical analysis, compliance and regulatory issues to accurately assess and manage inpatient and outpatient audit programs. Learn more about the CHCAF.

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