IAMI CPMA study plan

Map every CPT, ICD-10-CM, and HCPCS Level II code set referenced in the CPMA content outline to the documentation elements each requires, building a one-page reference sheet per code family

Explain the difference between coding for reimbursement, coding for quality reporting, and coding for risk adjustment, and identify where each creates audit exposure

Apply the four criteria of a compliant physician query (clinical indicator, reason for query, multiple-choice options, and provider response) to three written documentation scenarios

Distinguish documentation sufficiency requirements for evaluation and management level selection, including medical decision making versus time-based reporting

Identify the top ten documentation deficiencies cited in payer audits, such as missing signatures, cloned notes, unspecified diagnosis codes, and undocumented history elements

Sequence the seven stages of an audit lifecycle from scoping through corrective action monitoring, and state the required output of each stage

Differentiate internal, external, prospective, retrospective, concurrent, and focused audits by purpose, sample source, and typical findings

Draft audit work papers that document objective, scope, methodology, sampling rationale, and evidence trail to a standard that would survive external review

Compare statistical and non-statistical sampling methods and select the appropriate method for three stated audit scenarios

Write a root cause analysis for a hypothetical coding error pattern that separates individual error from systemic process failure

Perform a full medical record review of ten synthetic encounters, abstracting documented elements and comparing them against coded and billed data

Calculate error rates by category (code assignment, modifier use, documentation sufficiency, medical necessity) using a standard error-rate formula

Apply a data validation protocol to reconcile the encounter form, claim, and medical record for consistency across all three sources

Identify documentation that supports medical necessity for high-risk services such as modifiers 25 and 59, and articulate when the supporting documentation is insufficient

Build a data validation checklist that a reviewer can apply consistently across encounters and reviewers

Summarize the compliance program elements expected of a billing entity, including written policies, a designated compliance officer, training, auditing and monitoring, and enforcement and discipline

Explain how the False Claims Act, Anti-Kickback Statute, and Civil Monetary Penalties Law create distinct liability exposures, and give one audit-relevant example of each

Describe the role of the OIG Work Plan and how published enforcement priorities should shape an organization's audit risk assessment

Identify the reporting obligations and protections under the provider self-disclosure protocol and the Stark Law self-referral rules

Distinguish HIPAA privacy and security requirements that constrain how audit samples and findings may be stored, shared, and destroyed

Distinguish fraud, waste, and abuse by intent, and classify ten given scenarios into the correct category with a written rationale

Detect the red flags of upcoding, unbundling, phantom billing, duplicate claims, and services not rendered within a set of claim patterns

Explain how data analytics techniques such as peer comparison, frequency distribution, and outlier detection surface potential FWA

Design a monitoring plan that includes proactive auditing, employee reporting mechanisms, and response procedures for detected issues

Describe the investigation process from intake through resolution, including documentation, privilege considerations, and corrective action

Structure an audit report that includes objective, scope, methodology, findings, risk rating, recommendations, and management response, in that order

Write findings statements that separate the condition, criteria, cause, and effect so each finding is actionable and defensible

Translate error rates and confidence intervals into plain-language risk statements for executive and clinical audiences

Deliver a ten-minute verbal audit summary to a mock compliance committee, anticipating pushback on findings

Draft a corrective action plan with owners, timelines, and measurable success criteria that ties back to each finding

Apply the principles of auditor independence by identifying conflicts of interest in five scenarios and stating the required action for each

Explain confidentiality obligations around protected health information encountered during audits, including minimum necessary access and secure handling

Distinguish the auditor's obligation to report findings accurately from pressure to soften or suppress unfavorable results

Describe professional competence expectations, including when to escalate a question outside the auditor's expertise

Analyze three ethical dilemmas involving provider pushback, sampling bias, and self-review of one's own prior coding work

Conduct a risk assessment that ranks audit targets by claim volume, dollar exposure, prior error rate, and regulatory attention

Construct a risk-based audit plan for a hypothetical 12-month cycle with sampling approach, sample size rationale, and resource estimate

Calculate sample sizes for a given confidence level and margin of error, and explain the tradeoff between sample size and audit cost

Complete two timed full-length practice exams under exam conditions and score them by domain

Build a remediation plan targeting the two lowest-scoring domains from practice exam results