CHA Healthcare Auditor study guide
CHA Healthcare Auditor · Work through your exam, one topic at a time.
The Certified Healthcare Auditor (CHA) is a professional credential for auditors who examine the compliance, financial, and clinical operations of healthcare organizations. Candidates typically come from internal audit, revenue cycle and coding compliance, health information management, and regulatory compliance roles, and the credential signals that the holder can plan audits, gather and evaluate evidence, and report findings in a healthcare-specific regulatory context. The CHA Healthcare Auditor study guide has 9 sections and about 2,306 words.
01Healthcare Compliance and Regulatory Environment
Healthcare auditors must map a provider's obligations across overlapping regimes: Medicare Conditions of Participation and coverage rules, the False Claims Act (FCA), Anti-Kickback Statute (AKS), Physician Self-Referral (Stark) law, the Civil Monetary Penalties Law, HIPAA, and the Office of Inspector General (OIG) Compliance Program Guidance. Know the difference between a condition of payment (the claim is false if unmet) and a condition of participation (facility may lose certification).
333 words, about 2 min02Internal Audit Standards, Ethics, and Professional Practice
Candidates should understand the IIA's International Standards for the Professional Practice of Internal Auditing (the IPPF), the Code of Ethics (integrity, objectivity, confidentiality, competency), and the audit lifecycle from engagement planning through reporting and follow-up. Key concepts: independence (reporting lines, freedom from operational responsibility), objectivity (avoiding conflicts, disclosing impairments), due professional care , and the quality assurance and improvement program with internal and external assessments.
260 words, about 1 min03Audit Planning, Risk Assessment, and Scoping
Planning begins with understanding the entity, its regulatory exposure, and its control environment. Auditors build a risk assessment weighing likelihood and impact, then set scope (what is in/out) and objectives (what questions the audit answers).
256 words, about 1 min04Audit Evidence, Testing Methodologies, and Sampling
Audit evidence must be sufficient, appropriate, and reliable -original documents and system data generally outrank summaries. Testing approaches include inquiry, observation, inspection, recalculation, reperformance, and analytics.
241 words, about 1 min05Revenue Cycle and Billing/Coding Compliance Auditing
Revenue cycle auditing spans scheduling, registration, charge capture, coding, claim submission, and collections. Auditors test coding accuracy (ICD-10-CM/PCS, CPT/HCPCS), medical necessity , modifier use (e.g., -25, -59/X-modifiers), charge master integrity , and claim edits .
259 words, about 1 min06Clinical Documentation and Quality-of-Care Auditing
Clinical documentation auditing verifies that records support the care delivered and billed, and that quality indicators are met. Key concepts: documentation integrity (accuracy, completeness, timeliness, authentication), clinical indicators (e.g., HACs, PSIs, readmissions, mortality), and quality reporting programs (e.g., Hospital IQR, MIPS).
237 words, about 1 min07Privacy, Security, and Health Information Management (HIPAA)
HIPAA has three main rules: Privacy (uses/disclosures of PHI), Security (administrative, physical, technical safeguards for ePHI), and Breach Notification . Know the minimum necessary standard, the TPO (treatment, payment, operations) exceptions, patient rights (access, amendment, accounting of disclosures), and Business Associate Agreements.
251 words, about 1 min08Audit Reporting, Communication, and Follow-Up
Audit reports communicate findings, criteria, condition, cause, effect, and recommendations. A strong finding states the criteria (the rule), the condition (what was found), the cause , the effect (risk/dollars), and a recommendation .
233 words, about 1 min09Fraud, Waste, Abuse, and Investigative Auditing
Fraud is intentional deception for gain; waste is misuse of resources without intent; abuse is improper practice inconsistent with sound fiscal/medical/business practice, without intent. Auditors must recognize red flags (upcoding patterns, phantom billing, unbundling, services not rendered, identity theft, stark/anti-kickback arrangements).
236 words, about 1 min