ABQAURP’s Advanced Physician Advisor Core Body of Knowledge (APA CBK) is a comprehensive, self-paced course designed to provide an educational foundation for physician advisors and interprofessional health care team members involved in utilization management, care coordination, quality improvement, patient safety, and regulatory compliance and advances the mission to improve the quality of health care.

This comprehensive curriculum is focused on the core competencies of the physician advisor role and is recommended in preparation for the Advanced Physician Advisor and Health Care Quality and Management Board Certification Exams.

Pricing: Diplomate Members $300 - Professional Members $395 - Non Members $530

The six domains covered include:

• Medicare Compliance and Regulatory Obligations
• Utilization Review
• Care Management/Coordination
• Quality Measures and Metrics
• Clinical Documentation Integrity
• Leadership, Ethics, and Regulatory Guidance

The curriculum emphasizes collaboration among physicians, nurses, case managers, quality professionals, and health care leaders. Learners explore real-world strategies that support effective team-based decision-making, improved performance across the continuum of care, and better patient and organizational outcomes.

The Advanced Physician Advisor course is also beneficial for nurses, physician associates, and social workers; especially those working in utilization, quality improvement, case management, transitions of care, and QI committees or programs.

Delivered in a convenient, downloadable PDF format, the course allows learners to engage with content at their own pace while building practical knowledge applicable across inpatient, outpatient, and system-level care settings. Case studies and scenarios are interspersed throughout the course to provide additional context.

Upon completion of this activity, members of the interprofessional team should be able to:

• Apply core physician advisor leadership and utilization management principles across provider roles and settings to ensure regulatory compliance.
• Identify key Medicare beneficiary notices and the appropriate timing for their delivery (e.g., MOON, HINN, ABN).
• Explain the concept of medical necessity and its importance in the Two-Midnight rule, utilization review, level of care (inpatient vs. outpatient), and reimbursement.
• Define Medicare’s conditions of participation as relevant to the advisory role, such as in the discharge planning process and Utilization Review Committees.
• Manage denials using strategies such as improved tracking, evidence-based scoring tools, adherence to appeal time frames, and effective peer-to-peers.
• Collaborate effectively across disciplines to improve care transitions, promote resource stewardship, and produce quality outcomes, such as through the use of multidisciplinary rounds.
• Analyze quality measures and metrics through dashboards to reduce denials, limit avoidable days, reduce readmissions, and improve hospital throughput.
• Demonstrate the impact of documentation on ICD-10 coding, Diagnosis Related Groups (DRGs), complications and comorbidities (CCs), major complications and comorbidities (MCCs), and risk adjustment factor.
• Interpret federal laws and regulations impacting the health care team such as HIPAA, Stark Law, No Surprises Act, and the False Claims Act.

While the course is a valuable overview of the Physician Advisor role and continuing education credits earned may be counted toward exam eligibility requirements, it is not required and does not ensure successful completion of the Advanced Physician Advisor or Health Care Quality and Management Board Certification Exams.

Faculty includes:
Melissa M. Buchner-Mehling, MD, CHCQM, CPHYADV - Sound Physicians
Natasha L. Chen, MD, CHCQM, CPHYADV - Natasha L. Chen, LLC
Jonathan Cohen, MD, FACP, CHCQM, CPHYADV, ACPA-C - Maryland Physician Advisors, LLC
Timothy P. Connelly, II, MD, FACP, CHCQM-PHYADV - HCA Healthcare
Kimberly K. Garner, MD, JD, MPH, CHCQM - South Central Veterans Health Care Network
Kelley Garner, MPH, MLS(ASCP) CM
Hemant Gupta, MD, MSc., CHCQM-PHYADV-United Healthcare
Dinesh J. John, MD, MMM, CHCQM-PHYADV - Molina Healthcare
Cheri Lattimer, RN, BSN-National Transitions of Care Coalition
Diana M. Nims, MD, CHCQM-PHYADV - Sarasota Memorial Health System
Kathy Ellen Seward, MD, CHCQM-PHYADV - HPI Rounds
Sunil K. Sinha, MD, MBA, FACP, CHCQM - Sentara Health Plans
Jeffrey Wanner, MD, CHCQM - Sarasota Memorial Hospital

Faculty Disclosure
Members of the Education Committee, Planners, and Faculty have no relevant financial relationships with ineligible companies to disclose.

This activity is valid from February 12, 2026 – February 11, 2028.

Pricing:
Diplomate Members $300.00
Professional Members $395.00
Non-Members $530.00

ABQAURP offers a 15% discount to active military and Veterans on the Exam application and registration fees and CBK course. Please call ABQAURP at (800) 998-6030 for the promo code.