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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

2010 Salary Survey

AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

TABLE OF CONTENTS

EXECUTIVE SUMMARY ................................................................................................................ 2

GENERAL DEMOGRAPHICS.................................................................................................... 3 SALARY AND COMPENSATION............................................................................................... 6 SALARIES BY REGION ......................................................................................................... 7 SALARIES BY WORK SETTING ........................................................................................... 8 SALARIES BY YEARS WORKED IN MEDICAL AUDIT ........................................................ 9 SALARIES BY HIGHEST LEVEL OF EDUCATION ............................................................ 10 SALARIES BY CMAS CERTIFICATION .............................................................................. 11 REIMBURSEMENT FOR EXTERNAL MEDICAL AUDITORS............................................. 12

ADDITIONAL REFERENCE SOURCES ................................................................................ 13 ACKNOWLEDGEMENT ..................................................................................................... 13

AAMAS Salary Survey Disclaimer This survey shall be used for individual, personal, and confidential reference purposes only. This survey and the contents hereof are proprietary products of AAMAS. The contents of this survey may not, in whole or in part, be reproduced, copied, disseminated, or published without the expressed written permission by a duly authorized representative of AAMAS. Contained herein is aggregate data related to salaries with breakdowns by a number of categories. The data represents only that of the respondents and recognizes that actual salaries may vary widely based on circumstantial conditions. AAMAS expressly disclaims all liability for damages of any kind arising out of the use of the data resulting from this survey. Please direct questions, suggestions and comments regarding the 2010 AAMAS Salary Survey to:

American Association of Medical Audit Specialists 10200 W 44th Avenue, Suite 304 Wheat Ridge, CO 80033 Phone: 720-881-045 Fax: 303-422-8894 Email: [email protected]

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

EXECUTIVE SUMMARY

The American Association of Medical Audit Specialists (AAMAS) prepared a salary survey for distribution to its members and non-members in December of 2009. Surveys were sent to approximately 562 medical audit professionals, mostly members of AAMAS on December 22, 2009. In addition, members from the Association of Healthcare Internal Auditors (AHIA) and the HCPro subscribers were invited to participate in the survey. Of the 443 respondents, 261 were AAMAS members, a 46.4% rate of return. This is an excellent rate of return, ensuring a high validity of the data. In addition to the AAMAS survey respondents, 174 were non-members, 3 were not sure, and 6 did not respond to the question. The survey included 30 questions. The survey instrument was developed and finalized by AAMAS Advisor, Marilyn Balcita, RN, CMAS with participation from the AAMAS Board of Directors, other volunteers, and suggested additions from the Resource Center for Associations. The survey questions covered the following categories: General Demographics Compensation and Benefits Professional Demographics Specific Job and Management Responsibilities This report will only focus on the salary and compensation of medical auditors. A separate report will be posted in the web on the specific, expanded and management responsibilities of medical auditors. SALARY SURVEY HIGHLIGHTS $ $ $ $ CMAS certificants earn an average of over $8,000 more annually than non-certificants CMAS certificants earn an average annual salary of $72,083 A third of the respondents' earnings fall within the range of $55,001 and $70,000 per year Average Salary by Region 41% of the respondents in the Western Region earn an average of $78,333 per year Northeast Region: 42% earn an average of $65,000 per year Southern Region: 43% earn an average of 61,250 per year Midwest Region: 63% earn an average of $58,750 per year Hospital based medical auditors earn an average of $64,500 per year Independent Contractor/Consultant earn an average of $72,200 per year New medical auditors (1-5 years) in the audit field earn an average annual salary of $60,000. Medical auditors with 6-10 years audit experience earn an average annual salary of $62,500 Medical auditors with 21-25 years audit experience earn an average annual salary of $84,500

$ $ $ $ $

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

GENERAL DEMOGRAPHICS

Majority of respondents were AAMAS members for five (5) years or less. This represents (58%) of the membership. Those holding membership in AAMAS for six (6) years or more (41.9%) represent the core membership. Distribution of the survey respondents was heavily weighted to the Southern Region with 45.6% from this 17-state region of the country.

Slightly over half of the AAMAS members responding to this survey were Certified Medical Audit Specialist (CMAS). Majority of those certified had been carrying their CMAS credentials for nine years. These were the original group of medical auditors who took the first medical audit certification examination in 2000.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

While everyone responding to this question is not necessarily a member of AAMAS, 35.5% are 55 years of age or older. This is not a surprising result for medical auditors and for majority of the professionals in this field who is comprised mostly of nurses. The "nurse aging force" is a known fact in the United States. Similar response was reported from the 2008 case manager's salary survey administered by the Case Management Society of America (CMSA) where nearly 80% of their respondents fell between the ages of 46 and 65. (2008 Salary Trend Survey, CMSA).

A third of the respondents had been in the medical audit profession for at least five years. Recall that this survey was administered mostly online. The relatively high number of "younger" respondents could be attributed to the frequent use of electronic technology by medical auditors new to this field.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

The shift in the level of education from the "usual" Diploma in Nursing to Bachelor's degree demonstrates the expansion of this profession from the mostly nursing group to other fields in healthcare. In 2004, AAMAS conducted its first job task analysis to define the scope of medical audit. Diploma in Nursing ranked number one in the level of education during that study. This result parallels the 2010 RN Salary Survey conducted by Pathway Medical Staffing for RNs in non-clinical/non-bedside nursing positions in NY, NJ and PA where nearly three quarters of the RN surveyed held a Bachelor's degree. Similarly, the Association of PeriOperative Registered Nurses (AORN) 2009 Salary Survey reported a 35% response from nurses with BSN. Professional Licensure Professional Certifications

81% were Registered Nurses 9% Licensed Practical Nurses 10% a mix of Physicians, HIM

professionals Social Workers and other healthcare professionals It is not surprising to expect the majority of the respondents were in the nursing profession, although there is a slow increase in the nonnursing professionals (physicians and health information/coding) joining the medical audit work force. Over half of medical auditors responding to this survey carry additional certifications in coding through AAPC or AHIMA; while seventeen percent are certified in utilization management or case management

37% Certified Professional Coder 12% Certified Coding Specialists 9% Certified in Utilization Management 8% Certified Case Managers 7% Registered Health Information Technologist 5% Registered Nurse, Certified 4% Certification in Healthcare Compliance 3% each Certification in Critical Care, Operation Room, Healthcare Quality; and Registered Health Information Administration 1% Certified Fraud Examiner

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

SALARY AND COMPENSATION

The heaviest concentration of salaries for medical auditors fell between $55,001 and $70,000 per year; 33.1% of the respondents fit within this range. The next highest range (20%) is $40,001 to $55,000 followed by $70,001 to $85,000 (18.5%). Overall, salaries for medical auditors are spread across a wide spectrum. Seeking comparison trends from various publications conducting salary surveys from similar healthcare professionals in the country, the salary range of medical auditors are equally comparable with the annual salary of nurses working in clinical areas, as well as those who are performing non clinical tasks. According to the Advance for Nurses 2009 Salary Survey, the average annual salary for nurses nationwide is between $60-65k. CMSA reported a range of $60-65K per year for case managers. (2008 Salary Trend Survey, CMSA). Average earnings for a staff nurse responding to the 2009 AORN Salary Survey is $64.4k. Likewise, nurses were paid an average base earning of $64k according to the RN Magazine's 2009 Nurse Earnings Survey (conducted by Advanstar Communications Research Services). In 2008, the Association of Healthcare Internal Auditors conducted a survey for internal auditors (2008 AHIA Survey). Ten medical auditors responded to the average base salary question amounting to $64,995. Although this is a small sample, this average salary is still within the norm for this profession. (New Perspectives November 2008, Volume 27, Number 4). Another similar organization to compare salary earnings is the 10th Annual Profile of Health Care Compliance Officers administered by the Healthcare Compliance Association. Compliance Auditors earned an average of $ 57,612, while Coders made an average of $ 51,801.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

SALARIES BY REGION

The Western Region showed the highest level of salaries, with 15% of respondents in this region making from $90,000 to $100,000, 14% at $65,001 to $70,000, and 13% making $70,001 to $75,000. Taking into account these three categories and assuming a compensation level at the mid range for each category, 41% of the respondents in the Western Region earn an average of $78,333 per year. Using the same assumptions as those applied to the Western Region, the remaining averages are: $ $ $ $ Northeast Region: 42% earn an average of $65,000 per year. Southern Region: 43% earn an average of 61,250 per year. Midwest Region: 63% earn an average of $58,750 per year. Hawaii, Alaska, and Puerto Rico: Since there were only two respondents, the data for this category is not considered reliable.

These results were not too distant compared to the salaries by region administered by similar organizations. CMSA reported case managers participating in the 2008 salary survey from the Western region earning from $70,001 to $75,000. HCCA also reported an average of $67k for compliance auditors from the West, followed by the Northeast at $59k ­ a similar pattern as the earnings reported by medical auditors from this survey. Healthcare professionals in the West have been known to earn relatively higher salaries than the rest of the country. Even in the 2009 AAPC Salary Survey, administered by the American Association of Professional Coders, earnings of coders in the Pacific average $50k, the highest of all the groupings across the nation.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

57% of survey respondents work in acute care setting

SALARIES BY WORK SETTING

Using the same assumptions as those applied in the previous chart; here is a breakdown of salaries by work setting: $ $ $ $ $ Acute Care Hospital: 59% earn an average of $64,500 per year. Independent Contractor/Consultant: 67% earn an average of $72,200 per year.* Managed Care Organizations: 67% earn an average of $96,375 per year.* Physician's Office: 74% earn an average annual salary of $51,500. * Privately Owned Medical Audit Company: 71% earn an average annual salary of $75,000.* *The total number of respondents for each of these categories was insufficient to ensure the validity of the data.

As expected, acute care practice typically shows higher earning rates than non acute care settings. 2010 RN Salary Survey conducted by Pathway Medical Staffing for RNs reported an average of almost $90k earned by nurses in case management, UR, appeals/denials, QI and clinical documentation improvement roles from acute care setting in their survey conducted in the states of NY, NJ and PA. It can be argued that the cost of living in these three states is higher than most areas except for several urban cities across the nation. Twenty percent of the nurses working in inpatient and outpatient settings according to the Advance for Nurses 2009 Salary Survey earned between $60-70k. RN Magazine reported an average of $65.6k annual income for hospital nurses in 2009.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

SALARIES BY YEARS WORKED IN MEDICAL AUDIT

Using the same assumptions as above, here is a breakdown of salaries by years worked in medical audit: $ $ $ $ $ 1­5 years: 50% earn an average annual salary of $60,000. 6­10 years: 58% earn an average annual salary of $62,500. 11­15 years: 52% earn an average annual salary of $82,000. 16­20 years: 51% earn an average annual salary of $63,750. 21­25 years: 59% earn an average annual salary of $84,500.

Case managers are the closest health care professionals most medical auditors can be compared to, particularly for nurses. Like case managers, nurses who branched off to medical audit have already earned a significant number of work experiences in nursing or in healthcare before transitioning to medical audit. It is then expected that earnings would be parallel for medical auditors and case managers (CMSA 2008 Salary Survey). The only difference is for medical auditors with 11-15 years experience under their belt earning almost $12k more than the case managers. It is a known fact that most medical auditors held various roles as nurses in management or leadership capacities prior to becoming medical auditors. The ten medical auditors who earned an average of $65k from the 2008 AHIA Survey had been working in medical audit from 7-15 years.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

SALARIES BY HIGHEST LEVEL OF EDUCATION

As with the prior assumptions, here is a breakdown of salaries by highest level of education: $ $ $ $ $ Associate Degree: 54% earn an average annual salary of $60,000. Bachelors Degree: 53% earn an average annual salary of $62,500. Diploma in Nursing: 67% earn an average annual salary of $69,500. LPN Training Program: 57% earn an average annual salary of $70,000. Masters Degree: 62% earn an average annual salary of $94,750.

Medical auditors have varying levels of education ranging from completion of licensed practical nursing program (LPN), diploma in nursing, to doctor of medicine. This survey showed that ­ for medical auditors -- higher educational achievement does not always equate to higher salary. For example, fourteen LPNs completed this question and reported an average salary of $70k. In addition to a relatively small universe of LPNs who responded to this item, one can also conclude that perhaps years of medical audit experience, additional educational degree and/or management positions played significant roles in their reported earnings. This assumption can be confirmed by looking at the 2009 RN Salary Survey where it showed Diploma in nursing earning $2.3k more than BSNs and Associate degree in Nursing earning $2.1k more than BSNs. (2009 Nurse Earnings Survey). Similarly, a publication by Nursing magazine in 2006 also reported an almost $2k more earnings by diploma trained nurses than BSNs, likely attributed to years of experience by these nurses than their Bachelor trained colleagues.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

SALARIES BY CMAS CERTIFICATION

The averages for those who carry the CMAS certification are: $ CMAS Certified: 60% earn an average annual salary of $72,083. $ Not CMAS Certified: 78% earn an average annual salary of $63,890.

Certification Council

CMAS certificants earn an average of over $8,000 more annually than non-certificants. The responses to the cross matched data for those who have earned the CMAS designation would indicate that the credential is valued to some extent by employers of medical audit specialists since salaries for those with CMAS credential earn over $8,000 more than those who have not earned the credential One of the greatest achievements of this salary survey is providing evidence that CMAS certification is a strong earning weapon in spite of the economic challenges we are facing nowadays. While one cannot solely attribute the increase in the reported earning power of medical auditors to the CMAS certification, gaining recognition through certification in this field, in addition to a combination of variables such as years of experience, area/location of practice, type of clientele served and many others collectively play a significant role. It is a wise investment. Several articles from academic literature and other publications have been written (see reference sources) with regard to the benefits and favorable outcomes of obtaining specialty certifications especially in healthcare. Similar observations were widely noted nationally and internationally with regard to the positive benefits of certification from non healthcare professionals, internal auditors, quality auditors, project managers, and IT certified professionals to name a few. It ranges from the tangible and intrinsic value of increasing ones earning capacity, to serving as a safety mechanism benefiting the public, employers and the community, and for self gratifying empowerment (personal satisfaction) reasons.

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

We polled Certified Medical Audit Specialists asking then to rank the benefits gained from being certified as a CMAS. The result is listed from the highest ranking. 1. 2. 3. 4. 5. 6. 7. 8. 9. Personal satisfaction/achievement (ex: looks good on business cards) I serve as the subject matter expert regarding medical audit issues Recognition by my boss, my peers at work and the community My CMAS credential enhanced my career mobility Ease in obtaining clients/business and medical audit work Required by my employer Promotion Salary increase I received a bonus after obtaining CMAS

REIMBURSEMENT FOR EXTERNAL MEDICAL AUDITORS

We also polled external medical auditors to gauge what reimbursement schemes are being offered across region the nation. While the majority of external medical auditors are paid on an hourly basis, the rest of the reimbursement schemes varied but not by a wide margin. Note: R&B = room and board).

Additional reimbursement methods were also offered by respondents, namely: $ % of bill paid by insurance $ Bid or Flat Fee for Engagement $ Case rate $ Case Rate with set amount per account $ Flat rate/contract per job/day + expenses + per diem $ Paid per $10,000, including R&B $ R&B minus when bill over $300,000 $ Variable % of amount recovered from rebill to insurance company

www.aamas.org

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AMERICAN ASSOCIATION OF MEDICAL AUDIT SPECIALISTS

Additional Reference Sources

Achieve your professional best with ANCC certification. Overview of American Nurses Credentialing Center Certification and Magnet Hospitals: Will certification advance your career and improve patient outcomes? American Journal of Nursing. July 2006. Volume 7; Pages 74-76. Earning Power: 2009 Salaries Survey. Health Facilities Management. July 2009. Vol 22, 2009 Fitzpatrick JJ, Campo et al. Certification, Empowerment, and Intent to leave Current Position and the profession among Critical care Nurses. American Journal of Critical Care. 2010;19: 218-226 doi:10.4037/ajcc2010442 How employers view specialist certification. Physical Therapy magazine, January 2003. Information Technology 2008 Salary Survey. Certification Magazine Perceived value of certification among certified/non-certified and administrative Preoperative Nurses. Journal of Professional Nursing, July-August 2006. Piazza et al. Differences in perceptions of empowerment among nationally certified and non-certified nurse. Journal of Nursing Administration Vol. 3, No. 3 May 2006. Position Paper: The value of certification in Infusion Nursing. Journal of Infusion Nursing. September-October 2009 Promoting the value and increasing awareness of case manager certification Spring 2010 Commission for Case Manager Certification Newsletter. Quality Progress 2009 ASQ Salary Survey. December 2009. American Society for Quality Specialty Focus: Nursing certifications as a workforce strategy. Nursing Management. August 2008. Volume 39. Number 8 Value of nursing specialty certification study. American Board of Nursing Specialties 2006. Watts, M. Certification and clinical ladder as the impetus for professional development. Critical care Nursing Quarterly. Vol. 33. No.1, Jan-March 2010 Why Certify? The Benefits of Nursing Certification Medscape Posted: 03/05/2010.

Acknowledgement

This is indeed a milestone in the long chapter of outstanding achievements by the American Association of Medical Audit Specialists performed through serious commitment and hard work by the AAMAS Board of Directors and special volunteers that we were able to complete this survey successfully and on time. Foremost, thank you to each and every one of the 443 participants, who took time from their busy lives in completing this survey during the holiday period in late 2009. Special acknowledgment to the following individuals whose immeasurable support and encouragement I cannot ignore. To Nelda Fetters, RN CMAS (AAMAS Past President), Maria Petz, RN CMAS (AAMAS Communications Chair) and Leslie Spector, RN CMAS (current AAMAS President) special ladies in my AAMAS family who generously and willingly gave their "all" in supporting me during all phases of this project: from the production, design, testing to the report and analysis phase. To Bonnie Arp, RN CMAS and Cathy Mezmar, RN CMAS for their wit and brains in the survey instrument design. Rohm and Barb Thompson, RN CMAS thank you for your outstanding services as well. To David Stumph of Resource Center for Associations (RC), his team, and most especially to Barbara Trumbo for her extra-mile of patience dealing with me to perfect the survey instrument and production report. Lastly, to my family - for their never-ending patience and support during the completion of this project - front to end.

Marilyn Balcita, RN CMAS, AAMAS Advisor [email protected]

The AAMAS Salary Survey report is a reference tool that can be used by medical auditors, healthcare institutions and agencies, employers and the healthcare community at large. Questions and comments regarding this survey report must be directed to the AAMAS Administrative office referenced at the footer of this document. To request multiple copies for mass distribution, please contact the AAMAS Administrative office. All Rights Reserved.

www.aamas.org

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