Healthcare Accounting Regulatory Compliance & Auditing Flashcards

Under Sarbanes-Oxley Section 302, which officers of a publicly traded healthcare company must certify the accuracy of quarterly and annual financial reports?

Answer: Chief Executive Officer and Chief Financial Officer

SOX Section 302 requires the CEO and CFO to personally certify the accuracy and completeness of financial reports filed with the SEC, with criminal liability for false certifications.

A Medicare audit identifies that a hospital submitted claims using upcoded DRG assignments. Under the False Claims Act, which element is NOT required to establish liability?

Answer: The government suffered actual financial harm

The FCA does not require proof of actual damages; liability attaches upon submission of a false or fraudulent claim, even if the government has not yet paid or the payment has been recovered.

Which internal control framework is most widely used by healthcare organizations for designing and evaluating internal controls over financial reporting?

Answer: COSO Internal Control – Integrated Framework

The COSO Internal Control – Integrated Framework (2013) is the predominant framework used by healthcare organizations and their auditors to design, implement, and evaluate internal controls.

When a Medicare MAC issues a demand letter for an overpayment, a provider must request a redetermination within how many days to initiate the appeals process?

Answer: 180 days

Providers must file a redetermination request with the MAC within 120 days of receiving the initial determination to begin the five-level Medicare appeals process.

In healthcare revenue cycle auditing, the 'clean claim rate' metric measures which of the following?

Answer: The percentage of claims paid without manual intervention or denial

Clean claim rate measures the percentage of claims that are accepted and processed for payment by the payer on first submission without requiring correction, resubmission, or manual processing.

Under 42 CFR Part 2, which type of patient records receives stricter federal confidentiality protections than standard HIPAA requirements?

Answer: Substance use disorder (SUD) treatment records

42 CFR Part 2 imposes stricter confidentiality protections on substance use disorder treatment records, generally requiring patient consent for disclosure even to other treating providers.

A healthcare organization is assessing fraud risk during an audit planning phase. Which procedure best addresses the risk of management override of internal controls?

Answer: Examining journal entries and other adjustments for evidence of manipulation

AU-C Section 240 requires auditors to examine journal entries and other adjustments for unusual entries, particularly those made near period-end, to address the risk of management override.