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:
- 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
- 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
- 20 questions
- CPT coding concepts
- Modifier usage
- Diagnosis coding and medical necessity
- Evaluation and Management Documentation Guidelines
- Coding Guidelines versus carrier guidelines
- 11 questions
- Audit scope
- Statistical sampling
Audit Cases including:
- 52 questions (24 audit cases)
- Evaluation and Management
- Surgery
- Physical Therapy
- Radiology
- Psychiatry
- Hematology/Oncology
- Infusion Services
- 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
In addition, any officially published errata update sheets for these manuals
may be used. No other manuals are allowed. Examinees may use current calendar
year and/or previous year code books. However, it is strongly suggested that
only current manuals be used.
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
CPMA®(Certified Professional Medical Auditor) credential is a "base" credential,
with different requirements for CEUs. Each examination is separate and distinct
from one another. To obtain all certifications, each examination must be taken
separately and passed. Continuing Education Unit (CEU) submissions are required
for all certifications. For CEU requirements please see our CEU
Information page.
