Healthcare Accounting Regulatory Compliance & Auditing Flashcards

Which element distinguishes a Corporate Integrity Agreement (CIA) from other OIG enforcement tools?

Answer: It requires an Independent Review Organization (IRO) to conduct periodic audits

CIAs typically require the entity to engage an Independent Review Organization (IRO) to conduct claims reviews and systems reviews, with results reported to the OIG annually.

Under the Medicare Inpatient Prospective Payment System (IPPS), which entity assigns MS-DRG codes that determine hospital reimbursement?

Answer: The hospital's clinical documentation improvement (CDI) team and coding staff

Hospital coding and CDI staff assign ICD-10-CM/PCS codes that are grouped into MS-DRGs by the hospital's grouper software, which determines the IPPS payment rate.

A not-for-profit hospital receives a $5 million restricted grant for building a new cardiac wing. Under FASB ASC 958, how should this be initially classified?

Answer: Net assets with donor restrictions

Under FASB ASC 958-205, contributions with donor-imposed restrictions are classified as net assets with donor restrictions until the restriction is met or expires.

Which government auditing standard requires auditors to maintain independence and report on internal control over financial reporting for federal program audits?

Answer: GAO Government Auditing Standards (Yellow Book)

GAO Government Auditing Standards (the Yellow Book) establish requirements for auditor independence, reporting on internal control, and compliance in audits of government entities and programs.

In a healthcare compliance audit, which type of risk is defined as the risk that material misstatement will not be prevented or detected by the entity's internal controls?

Answer: Control risk

Control risk is the risk that a material misstatement that could occur will not be prevented, or detected and corrected, on a timely basis by the entity's system of internal control.

Under the Anti-Kickback Statute (AKS), which safe harbor protects compensation arrangements between hospitals and physicians for employment?

Answer: Employment safe harbor

The employment safe harbor under 42 CFR § 1001.952(i) protects remuneration paid by an employer to an employee for employment in the furnishing of covered items or services.

Which Medicare reimbursement methodology uses a prospective per-diem payment rate to reimburse skilled nursing facilities (SNFs)?

Answer: Patient Driven Payment Model (PDPM)

The Patient Driven Payment Model (PDPM), effective October 2019, replaced RUG-IV and uses a per-diem case-mix adjusted payment based on patient characteristics for Medicare SNF stays.