CCFA Core Curriculum

 

CCFA-Certified Clinical Financial Auditor
CCFA Core Curriculum

 

 

 

I. Medical Audit Proficiency 20%

    • Finance 
    • Statistics
    • HIM principles 
    • Accounting principles
    • Research methods

II. Medical Audit Professional Values 5%

    • Ethics
    • Standards of conduct
    • Policies
    • Confidentiality

III. Medical Audit Environment 15%

    • National Healthcare Audit Guidelines
    • Federal and State laws
    • NCD National Coverage Determination
    • HIPPA
    • Medicare, Medicaid and Insurance reimbursement methodologies
    • OIG and JCAHO

IV. Medical Audit Process and Procedure 60%

    • Coding and billing validation and accuracy ICD-10, CPT, HCPCS, E&M
    • Payment methodologies
    • Revenue code and charges validation
    • UB04-CMS 1450 and CMS 1500
    • Utilization review and denials
    • Contracting
    • Electronic health records, databases and spreadsheets

Click here to download the Core Curriculum

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