CPMA Exam Questions and Answers
100% Correct Certified Professional
Medical Auditor Examination Guide.
DOMAIN I: MEDICAL AUDITING FUNDAMENTALS (Questions 1-22)
Q1: An auditor reviews patient charts before claims are submitted to identify and correct
coding errors. This type of audit is called:
A. Retrospective audit
B. Prospective audit
C. Concurrent audit
D. Targeted audit
Correct Answer: B (Prospective audit)
Rationale: Prospective audits occur before claims submission, allowing for error correction to
prevent claim denials or overpayments. Retrospective audits occur after payment, and
concurrent audits occur during the patient's stay.
Q2: Which of the following is a key responsibility of a medical auditor regarding conflict of
interest?
A. Investing in companies owned by the provider being audited
B. Objectively applying guidelines regardless of financial relationships
C. Auditing family members' charts to ensure quality
D. Accepting gifts from the practice during the holiday season
Correct Answer: B (Objectively apply guidelines)
Rationale: Auditors must maintain independence and objectivity. Conflicts of interest
(financial or personal) must be disclosed and avoided to ensure the integrity of the audit.
,Q3: A utilization review nurse evaluates a patient's length of stay and treatment plan while
the patient is still hospitalized. This is an example of:
A. Prospective audit
B. Retrospective audit
C. Concurrent audit
D. External audit
Correct Answer: C (Concurrent audit)
Rationale: Concurrent audits take place during the patient's episode of care, allowing for real-
time intervention to manage resources and quality of care.
Q4: An auditor is hired to review only high-level Evaluation and Management (E/M) codes
(99214-99215) billed by a specific physician. This is an example of a:
A. Comprehensive audit
B. Random audit
C. Focused audit
D. External audit
Correct Answer: C (Focused audit)
Rationale: A focused audit has a narrow scope, targeting specific codes, providers, or services,
unlike a comprehensive audit which reviews a broad range of services.
Q5: What is the primary purpose of a retrospective audit?
A. To authorize services before they are rendered
B. To identify patterns of errors and recoup overpayments
C. To discharge a patient from the hospital
D. To verify provider credentials
Correct Answer: B (Identify patterns of errors and recoup overpayments)
,Rationale: Retrospective audits are performed after claims have been paid. They are used to
identify overpayments, underpayments, and patterns of non-compliance for education or
disciplinary action.
Q6: Which of the following best describes a "Targeted" audit scope?
A. Selecting charts using a random number generator
B. Reviewing every chart from the previous year
C. Selecting charts based on risk factors like high-dollar codes or OIG Work Plan areas
D. Reviewing charts for all providers in a multi-specialty clinic
Correct Answer: C (Selecting charts based on risk factors)
Rationale: Targeted audits are non-random and focus on areas identified as high-risk, such as
high-volume codes, high-dollar services, or services flagged by the OIG Work Plan.
Q7: According to HIPAA, the auditor must ensure the confidentiality of Protected Health
Information (PHI). Which action violates this principle?
A. Discussing a specific patient's medical record in a private conference room with the
compliance officer
B. Leaving an unlocked laptop containing audit data in a public café
C. Encrypting electronic audit files before emailing them
D. Shredding paper notes used during the audit after the review is complete
Correct Answer: B (Leaving an unlocked laptop containing audit data in a public café)
Rationale: PHI must be protected from unauthorized access. Leaving a laptop with PHI
unattended and unlocked is a security breach.
Q8: Who is responsible for the accuracy of the medical record documentation?
A. The medical auditor
B. The coding specialist
C. The treating physician/provider
, D. The billing department
Correct Answer: C (The treating physician/provider)
Rationale: The provider who performs the service is legally responsible for documenting the
care and ensuring the record is accurate, complete, and authenticated.
Q9: Which federal agency publishes the Work Plan that outlines focus areas for audits in the
coming fiscal year?
A. CMS (Centers for Medicare & Medicaid Services)
B. OIG (Office of Inspector General)
C. DOJ (Department of Justice)
D. OCR (Office for Civil Rights)
Correct Answer: B (OIG)
Rationale: The OIG Work Plan describes the areas the Office of Inspector General intends to
audit and evaluate in the coming year, serving as a guide for compliance officers.
Q10: Which auditing standard requires that the auditor's opinion be based on evidence and
not influenced by relationships?
A. Due Diligence
B. Subject Matter Expertise
C. Objectivity
D. Confidentiality
Correct Answer: C (Objectivity)
Rationale: Objectivity requires the auditor to be unbiased and independent, ensuring findings
are based solely on the evidence found in the medical record.
Q11: An auditor finds that a provider is consistently billing for services not documented. This
finding suggests a lack of:
A. Coding knowledge
100% Correct Certified Professional
Medical Auditor Examination Guide.
DOMAIN I: MEDICAL AUDITING FUNDAMENTALS (Questions 1-22)
Q1: An auditor reviews patient charts before claims are submitted to identify and correct
coding errors. This type of audit is called:
A. Retrospective audit
B. Prospective audit
C. Concurrent audit
D. Targeted audit
Correct Answer: B (Prospective audit)
Rationale: Prospective audits occur before claims submission, allowing for error correction to
prevent claim denials or overpayments. Retrospective audits occur after payment, and
concurrent audits occur during the patient's stay.
Q2: Which of the following is a key responsibility of a medical auditor regarding conflict of
interest?
A. Investing in companies owned by the provider being audited
B. Objectively applying guidelines regardless of financial relationships
C. Auditing family members' charts to ensure quality
D. Accepting gifts from the practice during the holiday season
Correct Answer: B (Objectively apply guidelines)
Rationale: Auditors must maintain independence and objectivity. Conflicts of interest
(financial or personal) must be disclosed and avoided to ensure the integrity of the audit.
,Q3: A utilization review nurse evaluates a patient's length of stay and treatment plan while
the patient is still hospitalized. This is an example of:
A. Prospective audit
B. Retrospective audit
C. Concurrent audit
D. External audit
Correct Answer: C (Concurrent audit)
Rationale: Concurrent audits take place during the patient's episode of care, allowing for real-
time intervention to manage resources and quality of care.
Q4: An auditor is hired to review only high-level Evaluation and Management (E/M) codes
(99214-99215) billed by a specific physician. This is an example of a:
A. Comprehensive audit
B. Random audit
C. Focused audit
D. External audit
Correct Answer: C (Focused audit)
Rationale: A focused audit has a narrow scope, targeting specific codes, providers, or services,
unlike a comprehensive audit which reviews a broad range of services.
Q5: What is the primary purpose of a retrospective audit?
A. To authorize services before they are rendered
B. To identify patterns of errors and recoup overpayments
C. To discharge a patient from the hospital
D. To verify provider credentials
Correct Answer: B (Identify patterns of errors and recoup overpayments)
,Rationale: Retrospective audits are performed after claims have been paid. They are used to
identify overpayments, underpayments, and patterns of non-compliance for education or
disciplinary action.
Q6: Which of the following best describes a "Targeted" audit scope?
A. Selecting charts using a random number generator
B. Reviewing every chart from the previous year
C. Selecting charts based on risk factors like high-dollar codes or OIG Work Plan areas
D. Reviewing charts for all providers in a multi-specialty clinic
Correct Answer: C (Selecting charts based on risk factors)
Rationale: Targeted audits are non-random and focus on areas identified as high-risk, such as
high-volume codes, high-dollar services, or services flagged by the OIG Work Plan.
Q7: According to HIPAA, the auditor must ensure the confidentiality of Protected Health
Information (PHI). Which action violates this principle?
A. Discussing a specific patient's medical record in a private conference room with the
compliance officer
B. Leaving an unlocked laptop containing audit data in a public café
C. Encrypting electronic audit files before emailing them
D. Shredding paper notes used during the audit after the review is complete
Correct Answer: B (Leaving an unlocked laptop containing audit data in a public café)
Rationale: PHI must be protected from unauthorized access. Leaving a laptop with PHI
unattended and unlocked is a security breach.
Q8: Who is responsible for the accuracy of the medical record documentation?
A. The medical auditor
B. The coding specialist
C. The treating physician/provider
, D. The billing department
Correct Answer: C (The treating physician/provider)
Rationale: The provider who performs the service is legally responsible for documenting the
care and ensuring the record is accurate, complete, and authenticated.
Q9: Which federal agency publishes the Work Plan that outlines focus areas for audits in the
coming fiscal year?
A. CMS (Centers for Medicare & Medicaid Services)
B. OIG (Office of Inspector General)
C. DOJ (Department of Justice)
D. OCR (Office for Civil Rights)
Correct Answer: B (OIG)
Rationale: The OIG Work Plan describes the areas the Office of Inspector General intends to
audit and evaluate in the coming year, serving as a guide for compliance officers.
Q10: Which auditing standard requires that the auditor's opinion be based on evidence and
not influenced by relationships?
A. Due Diligence
B. Subject Matter Expertise
C. Objectivity
D. Confidentiality
Correct Answer: C (Objectivity)
Rationale: Objectivity requires the auditor to be unbiased and independent, ensuring findings
are based solely on the evidence found in the medical record.
Q11: An auditor finds that a provider is consistently billing for services not documented. This
finding suggests a lack of:
A. Coding knowledge
