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Certified Professional Medical Auditor (CPMA®)

Advance your career with the Certified Professional Medical Auditor (CPMA®) credential. Medical auditing is a critical piece to compliant and profitable physician practices. Whether it's RAC audits, private payer denials or just peace of mind, more physicians plan to have regular audits done. The risks are getting too big to not be compliant with documentation and coding. As a Certified Professional Medical Auditor, you will be able to use your proven knowledge of coding and documentation guidelines to improve your or another practice's revenue cycle.

CPMA's have a good understanding of:

  • Knowledge of medical documentation, fraud, abuse, and penalties for documentation and coding violations based on governmental guidelines
  • Coding Concepts
  • Scope and Statistical Sampling Methodologies
  • Medical Record Auditing Skills and Abstraction Ability
  • Quality Assurance and Coding Risk Analysis
  • Communication of Results and Findings
  • The Medical Record

The CPMA® Exam

  • 150 multiple choice questions (proctored)
  • 5 hours and 40 minutes to finish the exam
  • 1 free retake
  • $325.00
  • Open code book (manuals)

The CPMA® exam thoroughly covers:

Medical Record Standards and Documentation Guidelines

  • 26 questions
  • The Medical Record
  • HIPAA Privacy and Release of Medical Record Information
  • Covered Entities
  • HIPAA Privacy Regulations
  • JCAHO Documentation Standards
  • Record Retention
  • The Advance Beneficiary Notification
  • Legal Requirements of the Medical Record
  • Analyzing the Operative Report

Coding and Documentation Compliance Guidelines

  • 32 questions
  • The Compliance Plan
  • Fraud and Abuse
  • Civil Monetary Penalties Law
  • Federal False Claims Act
  • Stark
  • Type of Audits
  • OIG Regulations and Workplan
  • National Correct Coding Initiative
  • CMS guidelines for E/M documentation
  • OIG imposed CIA (Corporate Integrity Agreements)
  • Recovery Audits and other government programs

Coding and Reimbursement Concepts

  • 20 questions
  • CPT coding concepts
  • Modifier usage
  • Diagnosis coding and medical necessity
  • Evaluation and Management Documentation Guidelines
  • Coding Guidelines versus carrier guidelines

Scope and Statistical Sampling Methodologies

  • 11 questions
  • Audit scope
  • Statistical sampling

Medical Record Auditing Abstraction

Audit Cases including:

  • 52 questions (24 audit cases)
  • Evaluation and Management
  • Surgery
  • Physical Therapy
  • Radiology
  • Psychiatry
  • Hematology/Oncology
  • Infusion Services

Category Risk Analysis and Communication

  • 9 questions
  • Validation of Audit Results
  • Analysis and Report of Audit Findings
  • Communicating Audit Results
  • Corrective Action

The majority of the questions are presented in multiple choice format covering auditing theory, legal and regulatory issues, NCCI, RAC audits, statistical sampling, coding concepts, and modifiers, etc. In addition, each test taker will need to audit approximately 20 health care cases.

Approved Manuals for Use During Examination

Note:
Electronic devices with an on/off switch (cell phones, smart phones, tablets, etc.) are not allowed into the examination room. Failure to comply with this policy may result in disqualification of your exam.

Any officially published errata for these manuals may also be used. No other manuals are allowed. Each code set is updated annually; it is essential that examinees use the current calendar year's coding manuals when taking the certification exam.

Individuals with a solid understanding of coding fundamentals, anatomy and terminology should be able to answer each examination question through application of the CPT®, ICD-9-CM or HCPCS Level II manuals or through careful reasoning.

Approved Exam Manuals/Exam Instructions

Non-Approved Manuals for Use During Examination

Due to the advantages of additional information and/or ease of use, the following books cannot be used during the exam:

  • Current Procedural Coding Expert® - Ingenix
  • Procedural Coding Professional - Contexo
  • Procedural Coding Professional - AAPC
  • Procedural Coding Expert - Contexo
  • Procedural Coding Expert - AAPC
  • CPT® Insider's View - AMA
  • CPT® Plus! - PMIC
  • Coders' Choice CPT® - PMIC
  • ICD-9-CM Easy Coder - Unicor

Exam Requirements
While there is no experience requirement, we strongly recommend that the candidate have at least two years of experience in medical auditing.

Please be aware that this is a difficult, high-level examination which is not meant for individuals with little, limited or no audit experience or training

  • We recommend having an associate's degree
  • Pay examination fee at the time of application submission
  • Maintain current membership with the AAPC
    • Renewing members must have a current membership at the time of submission and when exam results are released.
    • Renewing members must be current at the time of application submission as well as when results are sent
  • Materials to bring:

Exam Recommendation
The CPMA® examination is recommended for a certified coder or medical record auditor who has experience auditing physician services or significant coding experience and is well versed with a variety of different types of audits including but not limited to E/M services.  Auditing involves compliance and regulatory issues in its day to day work, and the examinee will be tested on these concepts in addition to coding, modifiers, NCCI usage, and more.

Maintaining Certification
Membership is required to be renewed annually and 36 Continuing Education Units (CEU's) must be submitted every two years for verification and authentication of expertise. For CEU requirements please see our CEU Information page.