Certified Professional Medical Auditor (CPMA)® Certification

As a CPMA, you will use your proven knowledge of coding and documentation guidelines to improve the revenue cycle of nearly all types of healthcare practices.
With tighter regulation on reporting medical services, there is a growing demand for CPMAs. They have a clear understanding of when and where an organization is at risk for non-compliance. CPMAs help providers avert liability and secure proper reimbursement for their patient care.

Certified Professional Medical Auditor (CPMA®) – Certification Exam

Exam format
100 multiple-choice questions

Online or in-person options
AAPC offers online and in-person proctored exams. Choose to take the exam at home in a quiet, private location or through your local chapter or a licensed instructor. Learn more about the online proctored exam and how to prepare for the current exam.

Time allowed
In-person and online exams are administered in one sitting, with four hours to complete the exam.

Equipment required for online exam
A reliable internet connection and an external webcam that can be positioned to show your face, hands, keyboard, and the area around the keyboard (about 10 inches) are required.

Experience requirements
Please be aware that the CPMA certification exam is a difficult, high-level examination and is not intended for individuals lacking training or experience. Examinees should have CPMA training and/or experience in auditing physician services, and be well versed in different types of audits, including evaluation and management (E/M).

Approved code books
AMA’s CPT® Professional Edition (current year)
ICD-10-CM (current year), any publisher
HCPCS Level II (current year), any publisher

Additional recommended resources: E/M audit worksheets of your choice
Because code sets are updated annually, it’s essential that you use the current calendar year’s code books when taking the certification exam. No other code books or references are allowed.

Maintaining your certification
To maintain your credential, you must maintain your AAPC annual membership, and earn 36 continuing education units (CEUs) every two years.

The CPMA Exam Pattern

The CPMA® Exam Pattern:
·    100 multiple choice questions (proctored)
·    4 hours to finish the exam
·    Open code book (manuals)
The majority of the questions are presented in multiple choice format covering auditing theory, legal and regulatory issues, NCCI, RAC audits, statistical sampling, coding concepts, and modifiers, etc. In addition, each test taker will need to audit approximately 18 health care cases.
 
The CPMA® exam thoroughly covers:
Medical Record Standards and Documentation Guidelines
·    17 questions
·    The Medical Record
·    HIPAA Privacy and Release of Medical Record Information
·    Covered Entities
·    HIPAA Privacy Regulations
·    JCAHO Documentation Standards
·    Record Retention
·    The Advance Beneficiary Notification
·    Legal Requirements of the Medical Record
·    Analyzing the Operative Report
 
Coding and Documentation Compliance Guidelines
·    21 questions
·    The Compliance Plan
·    Fraud and Abuse
·    Civil Monetary Penalties Law
·    Federal False Claims Act
·    Stark
·    Type of Audits
·    OIG Regulations and Workplan
·    National Correct Coding Initiative
·    CMS guidelines for E/M documentation
·    OIG imposed CIA (Corporate Integrity Agreements)
·    Recovery Audits and other government programs
 
Coding and Reimbursement Concepts
·    13 questions
·    CPT® coding concepts
·    Modifier usage
·    Diagnosis coding and medical necessity
·    Evaluation and Management Documentation Guidelines
·    Coding Guidelines versus carrier guidelines
 
Scope and Statistical Sampling Methodologies
·    7 questions
·    Audit scope
·    Statistical sampling
Medical Record Auditing Abstraction
Audit Cases including:
·    36 questions (18 audit cases)
·    Evaluation and Management
·    Surgery
·    Physical Therapy
·    Radiology
·    Psychiatry
·    Hematology/Oncology
·    Infusion Services
 
Category Risk Analysis and Communication
·    6 questions
·    Validation of Audit Results
·    Analysis and Report of Audit Findings
·    Communicating Audit Results
·    Corrective Action

 

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