CPMA Medical Auditor case studies
CPMA Medical Auditor · Put your knowledge to work in context.
The Certified Professional Medical Auditor (CPMA®) is a professional credential offered by AAPC, one of the largest training and credentialing organizations for the business of healthcare. AAPC lists the CPMA alongside its billing, compliance, documentation, and practice management credentials, and offers a dedicated medical auditing training course and a compliance training track that feed into it. The CPMA Medical Auditor case studies are 5 cases and about 4,559 words.
1The Standing Coinsurance Waiver at an Orthopedic Group's Captive PT Company
A three-physician orthopedic group bills Medicare Part B. Two years ago the group formed a wholly owned physical therapy LLC, and essentially all post-operative PT now goes there.
1,018 words, about 5 min2Modifier 25 Findings and the Limits of a Ten-Chart Sample
A twelve-provider group submits roughly 9,000 office E/M claims annually. The internal audit plan requires ten randomly selected charts per provider per year, drawn from a claims extract by the compliance analyst.
909 words, about 5 min3A Level 5 Exacerbation Visit with a Cloned Exam and a Same-Day Nebulizer
A family nurse practitioner documents this established-patient visit for a 68-year-old with COPD and type 2 diabetes. Chief complaint: shortness of breath.
828 words, about 4 min4Underpaid Contract Claims, a Six-Code Fee Schedule Load, and a Ninety-Day Appeal Window
A 40-provider multispecialty group holds a commercial contract paying 115% of the Medicare Physician Fee Schedule. A revenue-cycle analyst samples 60 paid claims across three months: 38 paid at 115% of Medicare and 22 paid at 100%.
862 words, about 4 min5Reporting a High-Producing Surgeon's Findings to a Resistant Medical Director
A compliance auditor completes a focused review of 24 charts for a surgeon who is the group's top revenue producer. Seventeen charts (71%) were billed 99215 with modifier 25 alongside a same-day procedure; the auditor concludes the documentation supports 99214 or lower on each.
942 words, about 5 min