HAC exam - which accounting topics actually show up the most?

I used the HFMA study guide plus a supplemental healthcare finance textbook and passed with a 77% after 11 weeks. The HFMA materials are a bit thin on cost report mechanics specifically - I'd recommend pulling the CMS cost report instructions as a supplement. They're free and very detailed.

The reimbursement methodology questions are tricky because they change as CMS updates its rules. Make sure whatever materials you use are from the last 18 months - I found older prep content with the wrong DRG weight methodology and it cost me several questions.

The distribution on my exam felt close to the outline - cost accounting and reimbursement questions were definitely the bulk of it. If you have a CPA background, the general GAAP stuff won't slow you down, which gives you more runway to focus on cost reporting and 340B program questions.

10 weeks from 59% is tight but your CPA background helps a lot. The people I know who struggled most were those without any accounting foundation at all. Give yourself permission to skip quickly through basic financial statement sections and load up on Medicare cost reporting instead.

Coming from a CPA background, I actually found the trickiest part wasn't learning the new material — sorry, I mean the hardest part was unlearning some general accounting intuitions that just don't apply in healthcare. Cost reporting and Medicare reimbursement showed up constantly on my practice tests. But here's what helped me more than anything: I stopped celebrating when I got a question right and started obsessing over why the wrong answers were wrong. Like, if you pick B and the answer's C, don't just accept it and move on. Figure out exactly what scenario would make A, B, and D correct, because the HAC loves to test edge cases that trip you up if you've only memorized the "normal" rule.

Fund accounting was lighter than I expected, but cost reporting and reimbursement methodology felt heavy. With your CPA background you'll pick up the concepts faster than most, but the healthcare-specific wrinkles are where people lose points. I'd drill practice questions and treat every wrong answer like a mini case study. It's slower, but by test day you're not just recalling facts, you actually understand the logic, which is what saves you on the weird questions you've never seen before.

Honestly, I almost bailed around week four because cost reporting felt like learning a foreign language and I couldn't see how it all connected. What actually saved me was stopping trying to memorize everything and just focusing hard on Medicare cost report structure and the difference between allowable and non-allowable costs -- that stuff shows up constantly. Fund accounting was lighter than I expected, maybe five or six questions, so don't let it eat your whole study schedule.

With your CPA background you're probably overthinking the accounting mechanics, which were the easy part for me too. The tricky questions were the ones mixing reimbursement concepts with operational decisions, like why a hospital would choose one cost allocation method over another. If you nail Medicare/Medicaid reimbursement principles and get comfortable with the cost report flow, you're in decent shape. It's hard but it's passable -- I passed with two weeks left to spare after thinking I'd never get there.