PMPC Designation study guide
PMPC Designation · Work through your exam, one topic at a time.
The Certified Medical Compliance Officer (CMCO) is a professional credential offered through the Practice Management Institute (pmiMD.com) for medical office personnel who build, run, and defend a practice's compliance program. It suits compliance officers, practice managers, billers and coders, auditors, and clinicians who own regulatory risk in an outpatient setting. The exam is organized into four equally weighted domains, each worth 25 percent: compliance structure and enforcements; billing, coding, coverage and reimbursement; compliance risks, actions and issues; and Medicare exclusion and its impact on an organization. Content reaches the seven elements of a compliance plan, health care fraud enforcement and sentencing guidelines, the False Claims Act, Stark and the Federal Anti-Kickback Statute, civil monetary penalty calculation, whistleblower complaints, LCDs and NCDs, the compliance officer's place in the organizational hierarchy, Medicare contractor types such as UPICs, ZPICs, RACs and SMERCs, audit response, permissive versus mandatory exclusion, overpayments and voluntary repayment, subpoenas and search warrants, and HIPAA/HITECH privacy concerns. The PMPC Designation study guide has 4 sections and about 1,242 words.
01Compliance Structure and Enforcement
A compliance program is judged by whether it is effective , not whether it exists on paper. The seven elements framework (written policies and procedures, a designated compliance officer and committee, effective training and education, open lines of communication, internal monitoring and auditing, response to detected offenses, and enforcement/discipline) is the backbone exam writers test.
356 words, about 2 min02Billing, Coding, Coverage, and Reimbursement
Candidates must distinguish code sets: ICD-10-CM for diagnoses, CPT and HCPCS Level II for procedures and supplies, and revenue codes for facility billing. Medical necessity links the diagnosis to the service; a payable claim requires correct coding, documented necessity, and covered status.
316 words, about 2 min03Compliance Risks, Actions, and Issues
Effective compliance begins with a documented risk assessment ranking exposure by likelihood and impact. High-risk areas typically include billing, coding, referral arrangements, privacy, and vendor relationships.
271 words, about 1 min04Medicare Exclusion and Organizational Impact
The OIG may exclude individuals and entities from federal health care programs for mandatory or permissive reasons. Mandatory bases include convictions for program-related fraud or patient abuse.
299 words, about 1 min