Free for HFMA Members
$399 for Non-members


Business Partners
Health Plans
Hospitals and Other Providers
Physicians and Other Practitioners

Career level:

Experienced Professional

Recommended for:

Healthcare Revenue Integrity
Managed Care

Delivery Method:

Self Study

Advance Preparation:

The coursework to prepare for the CICA assessment is available through Career Step LLC


Is intended for experienced coding professionals with at least 3 years of acute care inpatient coding experience. Participants should have a working knowledge of DRG assignment, case mix index, quality initiatives, MACs, RACs

Course Availability:

12 Months

Certification | Advanced | Coding

Certified Inpatient Coding Auditor (CICA)

Certification | Advanced | Coding

Certified Inpatient Coding Auditor (CICA)



The HFMA Certified Inpatient Coding Auditor (CICA) certification validates and acknowledges the expertise of the inpatient coding auditor professional. Certified inpatient coding auditors can help your organization ensure coding accuracy, increase reimbursements, and improve overall revenue cycle performance. The CICA certification is the only certification currently available to impatient coding auditors and it tests across all coding auditor responsibilities, including:
  • Documentation and coding accuracy and specificity
  • DRG assignment, case mix index, quality initiatives, MACs, RACs
  • The impact of accurate documentation and coding on overall revenue cycle
  • Compliance
The CICA certification assessment is hosted by HFMA. It is comprised on 150 multiple choice questions and must be completed within 3 hours. If participants do not pass the certification assessment on the first attempt, participants can have another attempt after a mandatory 30-day waiting period. A certificate of completion suitable for framing may be downloaded upon successful completion of the assessment. Recertification is required every two years (a minimal fee is charged for non-members).
After this program, you'll be able to..
  • Apply ICD-10-CM coding guidelines
  • Apply ICD-10-CM documentation requirements
  • Review skills required for complete ICD-10-CM coding and accurate reimbursement
  • Apply ICD-10-PCS coding guidelines
  • Apply ICD-10-PCS documentation requirements
  • Review skills required for completed ICD-10-PCS coding and accurate reimbursement
  • Describe the fundamentals of hospital inpatient auditing
  • Identify various audit types including internal and external, and random versus focused
  • Explain how to scope an audit based on audit type
  • Articulate how to analyze data and look for problem areas for targeted audits
  • Explain the impact of documentation on quality and reimbursement
  • Describe the difference between optimization and maximization
  • Understand clinical indicators, common treatments, and documentation requirements for common conditions in the major diagnostic categories (MDCs).
  • Identify HACs
  • Describe the high-risk, error-prone MS-DRGs
  • Understand what it takes to complete a successful audit
  • Understand the common, high-risk errors identified during an audit
  • Understand what impacts an MS/APR DRG
  • Explain the difference between Comorbidities (CCs) and Major Comorbidities (MCCs) and their impact on DRG assignment
  • Understand Case Mix Index (CMI) and how it is affected by DRGs
  • Explain the importance of Severity of Illness (SOI) and Risk of Mortality (ROM) and the impact on hospital/physician profiling
  • Understand the documentation requirements to support ICD-10 code specificity 
  • Understand and explain DRG hierarchy and optimization
  • Understand specific DRG scenarios and documentation requirements
  • Explain the impatient prospective payment system
  • Understand the Medicare Base Rate and how it is used with DRG calculations
  • Define HIPAA
  • Identify components of the Code of Ethics and Standards of Ethical Coding
  • Describe compliance risks
  • Sharpen written communication skills in a business context
  • Analyze information for clearly describe problems
  • Identify appropriate solutions
  • Communicate effectively using verbal and non-verbal technique
  • Develop key leadership skills, including techniques, for coaching, motivating, and delivering feedback
  • Describe healthcare law fundamentals
  • Explain upcoming and other high-risk billing practices

Related Courses | Coding

On Demand Webinar | Basic | Revenue Cycle

Managing and measuring the patient financial experience

While overall patient experience is almost always measured as part of quality metrics, in this age of healthcare consumerism, there is another critical metric that needs to be measured and understood-the patient financial experience. Patients today are seeking tools and solutions that support them as healthcare consumers and help them move forward with the care they need in a way that is easy and convenient.  Their ability (or inability) to understand and comfortably pay medical bills often carries as much weight as the overall quality of care received.

This webinar will address how healthcare organizations can implement systems to better understand patients' expectations, measure and improve the patient financial experience, and ultimately improve overall patient satisfaction scores.

Original live webinar date: 10/22/2019

Course | Basic | Physician Payment and Reimbursement

PPM: Coding and Payment Systems

This course discusses coding and payment systems, which establish the potential revenue of the physician practice. Other topics include fee schedules and relative value systems as well as compliance and rules for teaching physicians.

Estimated course completion time: 1 hour

Course | Overview | Denials Management

Denials Mgt: Revenue Cycle Performance Improvement

This course introduces the idea that lasting performance improvement in the revenue cycle can only be achieved after changing the work culture. The course also describes the ambulatory payment classification (APC) system introduced by the Centers for Medicare and Medicaid Services (CMS) in 2000. It also explains the importance of correct charging in avoiding denials, overcharges, and undercharges and describes how hospitals can prevent inaccurate charging before claims are submitted to payers and how hospitals can use retrospective audits to recover lost revenue from previously paid claims.

Estimated course completion time: 2 hours

Course | Overview | Compliance

Compl: Compliance and HIPAA Regulations

This course addresses the rise of corporate compliance programs in healthcare organizations, including their complexity and importance. It reviews the components of corporate compliance programs and the role of a compliance officer to know the statutes and regulations that govern all federal programs, and to operate within them. You'll know more about the Health Insurance Portability and Accountability Act (HIPAA), including electronic transaction code sets, and privacy and security components.

Estimated course completion time: 1 hour