CHA Healthcare Auditor study plan

Map the major federal healthcare compliance frameworks (False Claims Act, Anti-Kickback Statute, Stark, Civil Monetary Penalties) to the audit activities each one drives

Outline the structure of CMS Conditions of Participation and how they intersect with payer billing rules

Build a one-page reference chart of regulatory bodies (OIG, CMS, OCR, DOJ) and each one's enforcement role

Summarize the seven elements of an effective compliance program and state how an internal auditor tests each element

Trace how a regulatory requirement converts into a billing or coding control an auditor can test

Differentiate prospective vs. retrospective billing audits and select the appropriate approach for a given scenario

Explain the purpose and structure of a baseline billing audit and a focused medical record review

Identify the documentation elements a claim must support under medical necessity standards

Deconstruct the revenue cycle stages from scheduling through collections and name the control point at each stage

Apply E/M leveling and key coding conventions to determine whether a documented encounter supports the billed code

Calculate an overpayment and error rate from a provided sample of coded claims

Distinguish upcoding, unbundling, and duplicate billing and match each to a detection method

Draft a risk assessment that ranks auditable areas by likelihood and impact

Convert audit objectives into testable procedures and assign evidence sources to each procedure

Design a sampling plan (attribute vs. variable) and justify sample size and selection method

Classify evidence by reliability and identify the documentation needed to support a finding

Execute a walkthrough and document the control flow for a billing process end to end

Evaluate clinical documentation for medical necessity, specificity, and support of the billed services

Compare documentation quality findings against quality-of-care indicators and flag discrepancies

Write workpaper entries that link each test result to evidence and to the audit objective

Apply the IIA Code of Ethics and Standards to resolve at least three auditor-independence or objectivity dilemmas

Map HIPAA Privacy, Security, and Breach Notification Rule requirements to specific audit tests

Identify minimum necessary, access control, and audit-log requirements and describe how to test each

Explain how protected health information handling affects audit sampling, storage, and reporting

Differentiate fraud, waste, and abuse and identify red flags that warrant an investigative referral

Outline the steps of an investigative audit, including evidence preservation and chain of custody

Structure an audit report with criteria, condition, cause, effect, and recommendation

Draft a finding and a management response request that survive a challenge to accuracy and tone

Re-test weak areas from prior weeks with timed practice items across all nine domains

Revise the mock report after simulated management pushback and document the follow-up plan

Build a corrective-action tracker that assigns owners, due dates, and verification methods

Consolidate the highest-risk concepts into a one-page personal review sheet