Certified Professional Medical Auditor

Medical auditing is a critical element to ensure physicians’ practices are not only in compliance with applicable regulatory standards, but also ensures these practices are profitable in the short and long term. Federal Medicare and Medicaid regulations will begin to tighten after the passage and implementation of provisions from the Patient Protection and Affordable Care Act of 2010. To ensure compliance with these new regulations and also maintain revenue levels and overall profitability, many healthcare practices will require Certified Professional Medical Auditors to apply their skills in coding, documentation and compliance in providing audit services. This certification from the American Academy of Professional Coders (AAPC) ensures participants can provide various services from recovery audits to private payer denials – all services that help ensure accurate reporting and accounting for medical practices across the country.

This course is designed to prepare an individual to become an AAPC Certified Professional Medical Auditor (CPMA). Participants will be able to use their experience with coding and documentation guidelines in order to improve a practice’s revenue cycles. The CPMA examination is recommended for certified coders or medical record auditors with experience auditing physician services or significant coding experience and is well versed with a variety of different types of audits including, but not limited to E/M services. Auditing involves compliance and regulatory issues on a daily basis and examinees will be tested on these concepts in addition to coding, modifiers, National Corrective Coding Initiative (NCCI) usage, and more. Candidates should have at least 2 years of experience in medical auditing, though there are no set prerequisites necessary to complete this course. As such, AAPC recommends that most students have a minimum of an Associate’s Degree, as the CPMA exam is a difficult, high-level examination meant for individuals that have some measure of audit experience or training.

Class Objectives

After completing this class, learners will be able to:

• Explain the structure, composition, and organization of medical records according to government standards
• Describe coding and documentation guidelines, including regulatory control and compliance issues when auditing
• Explain the concepts and theories of coding as related to auditing and reimbursement
• Analyze the documentation auditing process
• Apply auditing guidelines for evaluation, management, surgical, physical therapy, radiology, psychiatric, hematological, oncological, and infusion services
• Explain what is audited, the methods of reporting an audit, and ways to present the findings