American Association of Medical Audit Specialists

 

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