IAMI CPMA case studies
IAMI CPMA · Put your knowledge to work in context.
The Certified Professional Medical Auditor (CPMA) is a credential for people who review healthcare documentation and claims for accuracy, completeness, and compliance. Candidates typically come from medical coding, billing, practice management, compliance, or clinical backgrounds and want to move into a review or oversight role rather than production coding. The IAMI CPMA case studies are 5 cases and about 3,234 words.
1Established Visit: Time Statement Includes Medical Assistant Time
An established 58-year-old patient with type 2 diabetes and hypertension is seen in a primary care clinic. The physician assistant (PA) documents: 'Total time on date of encounter: 42 minutes.
660 words, about 3 min2Missing Records and Extrapolation in an E/M Audit
A compliance auditor for a 40-provider multispecialty group is auditing outpatient E/M claims. The population is 12,000 claims for 99213–99215 from the prior year.
633 words, about 3 min3Incident-To Billing When the Physician Is Reachable Only by Phone
A 12-physician cardiology group employs a nurse practitioner (NP) who is credentialed with Medicare. The group bills all NP visits under the collaborating physician's NPI at 100% of the physician fee schedule, with no modifier.
680 words, about 3 min4High 99215 Rate, Modifier 25, and Cloned Documentation
A data analytics team flags a family medicine physician in a 60-provider network. The physician's 99215 rate is 68%, compared with 18% for peers; 92% of same-day E/M plus procedure claims carry modifier 25; average documented visit time is 12 minutes by EHR audit log, yet notes state 45–60 minutes.
635 words, about 3 min5Conflict of Interest and CFO Pressure on an Audit Finding
An independent auditor is engaged by a hospital's compliance department to audit 25 outpatient surgery claims. Before fieldwork, the auditor learns that their spouse is the clinic manager for the audited department.
626 words, about 3 min