CPMA Medical Auditor study guide
CPMA Medical Auditor · Work through your exam, one topic at a time.
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 study guide has 5 sections and about 1,638 words.
01Compliance and Ethics: Program Elements, Statutes, and Judgment Calls
Every candidate should be able to recite the seven elements of an effective compliance program without notes: written policies and procedures; a designated compliance officer and compliance committee with defined authority; effective training and education; open lines of communication (including anonymity and non-retaliation); internal monitoring and auditing; enforcement and discipline; and prompt corrective action and prevention. Questions often test the function of an element rather than its name - a hotline employees are afraid to use fails the communication element even though the hotline exists.
323 words, about 2 min02Auditing and Monitoring: Building a Defensible Sample and Following Through
Monitoring is ongoing, built into the workflow, and preventive - pre-bill edits, monthly supervisor chart checks, dashboards. Auditing is retrospective, independent, and systematic: a defined population, a defined period, a documented methodology.
315 words, about 2 min03Documentation and Coding Review: What the Record Must Support
The medical record must support the code on the claim. The classic formulation - if it was not documented, it was not done - decides most audit findings.
346 words, about 2 min04Reimbursement and Revenue Cycle: Following the Dollar End to End
Revenue cycle runs from scheduling and eligibility through registration, documentation, charge capture, coding, claim editing, submission, adjudication, posting, denial management, and collections. Every handoff is a potential leak.
324 words, about 2 min05Audit Reporting and Communication: Turning Findings into Action
A finding without a written, evidenced report does not exist. Each finding should carry the criteria (rule, policy, or contract requirement), the condition (what you actually found, with counts), the cause, the effect or risk, and a recommendation with an owner and a due date.
330 words, about 2 min