Find what an auditor would find, before an auditor does.
Payers, RAC contractors, and CMS reviewers test claims against the record, not against intent. HHS-OIG names auditing and monitoring as one of the elements of an effective compliance program, yet many practices have never had an independent audit. Our CPMA-certified auditors review a sample of every provider’s encounters end to end: coding and E/M levels, documentation and medical necessity, modifiers and NCCI edits, charge capture and billing, risk adjustment, and the compliance program itself. Each finding carries the record line and the rule behind it, then becomes provider education and a corrective plan. Six months later, the second audit shows whether the fixes held.
An independent audit, run end to end by certified auditors. Twice a year, for every provider.
Payers, RAC contractors, and CMS reviewers judge a claim by the record behind it. Coding drift, cloned notes, and modifier habits go unnoticed until a payer review or a refund request finds them.
CPMA-certified auditors test a sample of every provider’s encounters against the documentation, coding guidelines, NCCI edits, payer policy, and the HHS-OIG compliance guidance, then turn each finding into education and a corrective plan.
Inside CPMA Audit Program
Every capability below exists because a practice asked for it. Nothing here is a roadmap item.
Coding and E/M levels
CPT, ICD-10-CM, and HCPCS checked against the note; E/M levels tested against medical decision making or total time under current AMA and CMS guidelines.
Documentation and medical necessity
Signatures, dates, authentication, and whether the record supports the service billed.
Modifiers and NCCI edits
Modifier 25, 59, and X{EPSU} use, NCCI procedure-to-procedure edits, and MUE limits.
Charge capture and billing
Visits matched to charges and claims matched to documentation, so missed and incorrect charges surface.
Risk adjustment and HCC
Submitted diagnoses tested for MEAT support and specificity, the way a RADV reviewer reads the chart.
Compliance program review
Auditing and monitoring measured against the HHS-OIG General Compliance Program Guidance, including exclusion screening.
Findings by provider, each one sourced.
Every finding shows the encounter, the code billed, the code supported, the rule behind it, and the dollar impact. The report shown is illustrative, not real practice data.
| Provider | Sample | Accuracy | Next step |
|---|---|---|---|
| Provider A | 20 encounters | 90% | MDM refresher |
| Provider B | 20 encounters | 80% | Corrective plan |
| Provider C | 20 encounters | 85% | HCC education |
| Encounter | Area | Billed | Supported | Rule | Result |
|---|---|---|---|---|---|
| Provider A · Enc. 1042 | E/M level | 99214 | 99213 | AMA E/M MDM table | Overcoded |
| Provider A · Enc. 1077 | Modifier 25 | 99213-25 | 99213-25 | Separate, significant E/M | Supported |
| Provider B · Enc. 2210 | NCCI edit | 20610 + 76942 | 20611 | NCCI PTP pair | Unbundled |
| Provider C · Enc. 3305 | HCC support | E11.40 | E11.9 | MEAT not met for neuropathy | Specificity |
Illustrative example · not real patient data · providers, encounters, and accuracy figures are invented
From the schedule to the signed record
Scope and sample
Audit focus agreed per provider and specialty, and a statistically sound sample of encounters pulled.
Audit the record
CPMA-certified auditors review each encounter against the documentation, coding guidelines, payer policy, and your contracts.
Report and educate
Accuracy, findings, and financial impact for every provider, then one-on-one education and a corrective plan.
Re-audit in six months
The second audit of the year measures whether the fixes held and resets the plan.
Facts, not promises.
These are properties of how CPMA Audit Program is built, not projected savings. Results in your practice depend on your payers, your panel, and your documentation.
A baseline audit, then a re-audit six months later
Coding, documentation, modifiers, billing, risk adjustment, and compliance
Both audits, the findings report, education, and the corrective plan
End-to-end audits by CPMA-certified auditors.
Every audit tests the same areas payers, RAC contractors, and CMS reviewers check, and every finding cites the record line and the rule behind it.
Coding and E/M levels
CPT, ICD-10-CM, and HCPCS codes checked against the note. E/M levels tested against medical decision making or total time under the current AMA and CMS guidelines.
Documentation and medical necessity
Does the record support the service billed? Signatures, dates, authentication, and the medical necessity the payer will look for.
Modifiers and NCCI edits
Modifier 25, 59, and X{EPSU} use, NCCI procedure-to-procedure edits, and MUE limits, the patterns payers and auditors check first.
Charge capture and billing
Visits matched to charges, claims matched to the documentation, and payments matched to contracted rates, so missed and incorrect charges surface.
Risk adjustment and HCC
Submitted diagnoses tested for MEAT support and specificity, the same way a RADV or payer risk adjustment reviewer reads the chart.
Compliance program review
Auditing and monitoring measured against the HHS-OIG General Compliance Program Guidance, including exclusion screening and corrective action follow-through.
Twice a year, for every provider.
Scope and sample
We agree the audit focus per provider and specialty and pull a statistically sound sample of encounters.
Audit the record
CPMA-certified auditors review each encounter against the documentation, coding guidelines, payer policy, and your contracts.
Report by provider
Accuracy, findings, and financial impact for every provider, with the record line behind each finding.
Educate and correct
One-on-one provider education and a corrective action plan your compliance lead can track.
Re-audit in six months
The second audit of the year measures whether the fixes held and resets the plan.
CPMA stands for Certified Professional Medical Auditor, a credential from AAPC. The exam covers medical record standards and documentation guidelines, coding and billing rules such as NCCI, regulations including the False Claims Act and Stark Law, audit scope (including RAC audits), statistical sampling, and how to communicate findings and corrective action. An audit led by a CPMA is built on that discipline, not on opinion.
A good fit when…
- Practices that have never had an independent coding and compliance audit
- Groups adding providers, specialties, or new E/M documentation habits
- Organizations preparing for payer, RAC, or RADV reviews
- Compliance leads who need documented evidence of auditing and monitoring
The questions leaders ask first.
Don’t see yours? Bring it to a working session and we’ll walk it through with your data.
A signed BAA, read-only access to your EHR and billing system, and your provider list. We pull the sample; your staff do not prepare charts.
See CPMA Audit Program on your own workflow.
Tell us what your organization is fighting (open care gaps, documentation, denials, coverage) and we will walk you through the part of the platform that closes it.