Healthcare Accounting Regulatory Compliance & Auditing Flashcards

A healthcare organization discovers a self-disclosed overpayment from Medicare. Under the 60-day rule, from which date does the repayment clock begin?

Answer: The date the overpayment is identified

Under 42 U.S.C. § 1320a-7k(d), a provider must report and return an overpayment within 60 days of the date on which the overpayment is identified.

Which Medicare cost report worksheet captures a hospital's capital-related costs for PPS reimbursement purposes?

Answer: Worksheet B-1

Worksheet B-1 of the Medicare Cost Report (Form CMS-2552) captures capital-related costs including depreciation, interest, and lease costs for cost apportionment purposes.

Under HIPAA's Breach Notification Rule, when must a covered entity notify HHS of a breach affecting 500 or more individuals?

Answer: Without unreasonable delay and within 60 days of discovery

45 CFR § 164.408 requires covered entities to notify HHS of breaches affecting 500 or more individuals without unreasonable delay and no later than 60 calendar days after discovery.

In healthcare auditing, the statistical sampling method that gives every item in a population an equal chance of selection is called:

Answer: Simple random sampling

Simple random sampling ensures every item in the population has an equal and independent probability of selection, making it the most fundamental probability-based sampling method.

Which federal law requires Medicare Advantage plans and Part D sponsors to have effective compliance programs with mandatory training and a compliance officer?

Answer: 42 CFR Part 422 and Part 423

42 CFR Part 422 (Medicare Advantage) and Part 423 (Part D) mandate compliance program requirements including a compliance officer, training, auditing, and monitoring for plan sponsors.

A healthcare accountant is calculating the net realizable value of accounts receivable. Which adjustment must be made to gross patient service revenue?

Answer: Subtract contractual allowances and charity care write-offs

Net realizable value of accounts receivable equals gross charges minus contractual allowances, charity care adjustments, and other deductions from revenue to reflect expected collections.

Which OIG tool allows healthcare providers to voluntarily disclose potential fraud before a government investigation begins, typically resulting in reduced penalties?

Answer: OIG Self-Disclosure Protocol (SDP)

The OIG Self-Disclosure Protocol allows providers to voluntarily disclose potential fraud violations, with the OIG generally requiring a minimum multiplier of 1.5 times the single damages amount.