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Certified Professional Medical Auditor (CPMA®) - Certification Exam

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 Recovery Audit Contractor (RAC) audits, private payer denials, or just peace of mind, more physicians plan to have audits conducted regularly. The risks of being non-compliant with documentation and coding are too great. As a CPMA, you will be able to use your proven knowledge of coding and documentation guidelines to improve the revenue cycle of nearly all healthcare practices.

CPMA

Earn an Impressive Salary as a CPMA

With tighter regulation on reporting medical services, CPMAs must have a clear understanding of when an organization is at risk for non-compliance. That's why CPMAs are invaluable to healthcare organizations. They help providers avert liability and secure proper reimbursement for their patient care. As a result, CPMAs are well compensated, earning on average $70,320 annually, according to AAPC's 2022 Medical Coding Salary Survey.

Certified CPMAs demonstrate expertise in:

  • 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
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The CPMA® Exam

  • 100 multiple choice questions (proctored)
  • 4 hours to finish the exam
  • Open code book (manuals)

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 18 health care cases.

The CPMA® exam thoroughly covers:

  • 17 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
  • 21 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
  • 13 questions
  • CPT® coding concepts
  • Modifier usage
  • Diagnosis coding and medical necessity
  • Evaluation and Management Documentation Guidelines
  • Coding Guidelines versus carrier guidelines
  • 7 questions
  • Audit scope
  • Statistical sampling

Audit Cases including:

  • 36 questions (18 audit cases)
  • Evaluation and Management
  • Surgery
  • Physical Therapy
  • Radiology
  • Psychiatry
  • Hematology/Oncology
  • Infusion Services
  • 6 questions
  • Validation of Audit Results
  • Analysis and Report of Audit Findings
  • Communicating Audit Results
  • Corrective Action

Approved Code Books for Use During the CPMA Exam

Because code sets are updated annually, it's essential that you use the current calendar year's code books when taking the certification exam.

Confirm what reference materials are allowed during the CPMA certification exam.

Exam Book Bundle 2022 (CPT®, HCPCS, ICD-10-CM)

Exam Book Bundle 2022 (CPT®, HCPCS, ICD-10-CM)

AMA CPT® Professional 2022 - Now Shipping
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Exam Bundle includes the AMA CPT® Professional, ICD-10-CM Expert, and HCPCS Level II Expert — the three code books students need for nearly every AAPC exam, including AAPC’s Certified Outpatient Coder (COC) exam.

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 the above code books may also be used.

Exam Instructions

CPMA Certification Requirements

Please be aware that the CPMA certification exam is a difficult, high-level examination and is not intended for individuals lacking training or experience. Certified coders should have CPMA training and/or experience in auditing physician services — and preferably be well versed in different types of audits, including E/M.

Additional Requirements

  • Maintain annual AAPC membership
    • New members must submit membership fee prior to or with exam application.
    • Renewing members must have a current membership at the time of exam application and/or when exam results are released.
  • Certified specialists are required to complete 36 Continuing Education Units (CEU's) every two years. For CEU requirements please see our CEU Information

Note:

An overall score of 70% or higher is required to pass the certification exam. If you don’t pass, the areas of study/categories with a score of 65% or less will be provided for your preparation to retest. The areas of study reported reflect scores based on the number of questions in each category/section of the exam.

The CPMA certification exams exclusively measure proficiencies relating to performing the duties of a CPMA. To earn additional credentials requires you to pass additional certification exams.

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