ABOUT:

Medical auditing stands as a cornerstone in ensuring compliant and financially sustainable physician practices. With the Certified Professional Medical Auditor (CPMA^®) credential, individuals leverage their expertise in coding and documentation guidelines to enhance the revenue cycle across various healthcare settings. CPMA^® professionals demonstrate proficiency in a range of areas, including medical documentation, fraud detection, and adherence to governmental guidelines. Their skills encompass medical record auditing, quality assurance, and coding risk analysis, enabling effective communication of findings and recommendations. By utilizing their knowledge to optimize coding and documentation practices, CPMA^®s play a vital role in fostering compliant and profitable physician practices, ultimately contributing to the delivery of quality patient care.

CERTIFICATION BODY: AAPC^® – American Academy of Professional Coders (AAPC^®)

LEARNING OBJECTIVE:

• Define Fraud and Abuse: Gain understanding of fraud and abuse concepts and outline regulatory guidelines for key regulations governing healthcare practices.
• OIG Work Plan and CIAs Impact: Acquire knowledge on the significance of the OIG Work Plan and Corporate Integrity Agreements (CIAs) in shaping compliance practices.
• Compliance Plan Elements: List components of compliance plans and identify potential risk areas to ensure adherence to regulatory requirements.
• NCCI and MUE Risk Areas: Identify National Correct Coding Initiative (NCCI) and Medically Unlikely Edit (MUE) risk areas to mitigate billing errors and compliance risks.
• RAC Audit Preparation: Understand the purpose of recovery audit contractors (RACs) and learn how to prepare effectively for potential RAC audits.
• HIPAA Privacy Rule: Explain the HIPAA privacy rule, covering protected health information, minimum necessary standards, information sharing, and enforcement mechanisms.
• Documentation and Record Retention: Identify medical record documentation and retention standards to ensure compliance with regulatory requirements.
• Common Documentation Errors: Recognize common errors in documentation across various healthcare services, including evaluation and management, anesthesia, surgery, radiology, pathology, laboratory, and medicine services.
• Types of Audits and Resources: Define different audit types and outline the resources required for conducting audits effectively.
• Audit Process Steps: Explain the steps involved in the audit process, including identification, planning, execution, and reporting, and identify various statistical sampling methods and factors.
• Aggregate Analysis: Understand the concept of aggregate analysis and its utility in identifying trends and patterns for performance improvement and compliance monitoring purposes.

EXAM INFORMATION:

• Exam Format: The examination consists of 150 multiple-choice questions, administered under proctored conditions.
• Duration: Candidates are allotted 5 hours and 40 minutes to complete the exam.
• Open Code Book Test: The exam allows candidates to utilize manuals or code books during the test.
• Passing Score: To pass the exam, candidates must achieve a minimum score of 70%.
• Question Types: The exam assesses candidates’ recall, application, and analysis abilities through a variety of question types, ensuring comprehensive evaluation of knowledge and skills.

RE CERTIFICATION:

• Renewal Requirement: CPMA® credential renewal is required every two years.
• Continuing Education Units (CEUs): Renewal can be achieved by earning 36 Continuing Education Units (CEUs) through approved educational activities.