Mixed Deck — All HAC Topics Flashcards

When a Medicaid beneficiary receives services from a non-participating (out-of-network) provider in a non-emergency situation, the typical outcome is:

Answer: The claim is denied and the provider cannot bill the patient

In most Medicaid managed care plans, out-of-network non-emergency services are denied, and federal rules generally prohibit providers from balance-billing Medicaid patients.

Which National Correct Coding Initiative (NCCI) edit prevents billing two codes together when one is considered a component of the other?

Answer: Column 1/Column 2 Edit (Comprehensive/Component Edit)

Column 1/Column 2 edits (Comprehensive/Component edits) bundle a component code (Column 2) into a more comprehensive code (Column 1), preventing separate billing.

Which of the following transactions between a tax-exempt hospital and its board chair at below-market rates would most likely trigger IRS scrutiny under the private benefit doctrine?

Answer: The hospital leasing space to the board chair's private practice at 50% of fair market rent

Providing an economic benefit to a board member at below-market rates constitutes private benefit and may constitute an excess benefit transaction under IRC Section 4958.

The Medicare Physician Fee Schedule (MPFS) calculates payments using three components of the Relative Value Unit (RVU). Which of the following is NOT one of those components?

Answer: Overhead Facility RVU

MPFS uses Work, Practice Expense, and Malpractice RVUs — there is no separate 'Overhead Facility RVU' component.

Which GAAP principle requires a hospital to recognize physician bonus expense in the period the bonus was earned, even if it is paid in the next fiscal year?

Answer: Matching principle

The matching principle requires expenses to be recorded in the same period as the related revenue, so bonuses earned in the current year must be accrued regardless of the payment date.

Under the False Claims Act, what is the minimum per-claim civil monetary penalty for knowingly submitting a false claim to Medicare or Medicaid?

Answer: $11,803

As of recent adjustments, the False Claims Act civil penalty range is approximately $13,946 to $27,894 per claim (inflation-adjusted), with the lower bound near $11,803 in earlier adjustment periods.

A hospital switches EHR vendors. Which financial data migration risk poses the greatest threat to revenue continuity?

Answer: Incomplete migration of open AR balances and payer contract rates

Open AR balances and payer contract rates must migrate accurately; errors result in lost revenue, incorrect adjudication, and billing delays.

Which form is used to bill Medicare for outpatient and professional services?

Answer: CMS-1500

The CMS-1500 form is used by physicians and other healthcare professionals to bill Medicare for outpatient and professional services.

What is the primary goal of Tax-Exempt Organization Accounting in Healthcare Accounting Certification?

Answer: Ensuring accuracy, compliance, and financial integrity

Tax-Exempt Organization Accounting in Healthcare Accounting Certification focuses on maintaining accuracy, compliance, and financial integrity.

Which financial statement provides an overview of an organization’s financial position at a given time?

Answer: Balance sheet

The balance sheet is a fundamental financial statement that provides a snapshot of an organization's financial position at a specific point in time. It details assets (what the organization owns), liabilities (what it owes), and equity (the residual value to owners). This statement adheres to the accounting equation: Assets = Liabilities + Equity.

Which metric best evaluates a healthcare organization's liquidity position for short-term obligations?

Answer: Days cash on hand

Days cash on hand measures how many days of operating expenses can be covered by unrestricted cash and equivalents, directly assessing short-term liquidity.

Under ASC 805, which of the following acquired items in a healthcare M&A transaction would most likely be classified as an in-process research and development (IPR&D) asset?

Answer: A drug formulation that completed Phase II trials but has not yet received FDA approval

IPR&D assets under ASC 805 are research and development projects that have not yet reached technological feasibility or regulatory approval at the acquisition date.

A change in the estimated useful life of a depreciable healthcare asset is accounted for as:

Answer: A change in accounting estimate applied prospectively

Under ASC 250, a change in useful life is a change in accounting estimate and is applied prospectively to current and future periods without restating prior periods.

Post-acquisition, a hospital discovers that the acquired entity had an unrecorded malpractice liability that existed at the acquisition date. During the measurement period, this should be:

Answer: Recorded as an adjustment to goodwill retrospectively to the acquisition date

Pre-existing liabilities discovered during the measurement period are adjusted retrospectively by revising the purchase price allocation and adjusting goodwill.

In a healthcare organization, 'contribution margin' is calculated as:

Answer: Net revenue minus total variable costs

Contribution margin = Net revenue − Variable costs; it represents the amount available to cover fixed costs and generate profit.

Which revenue cycle metric tracks the percentage of claims denied by payers out of total claims submitted?

Answer: Denial rate

Denial rate is calculated as total denied claims divided by total claims submitted, expressed as a percentage.

Which COSO component requires management to identify and analyze risks that could prevent achievement of organizational objectives?

Answer: Risk Assessment

Risk Assessment is the COSO component where management systematically identifies and evaluates risks relevant to achieving objectives.

Which ratio measures a hospital's ability to cover its long-term debt obligations from operations?

Answer: Debt service coverage ratio

Debt service coverage ratio equals income available for debt service (operating income plus depreciation and amortization) divided by annual debt service requirements.

Which EHR security control best protects the integrity of financial transaction data from unauthorized modification?

Answer: Audit logging with tamper-evident trails

Tamper-evident audit logs record every modification to financial records, providing an immutable trail that detects unauthorized changes.

Which term describes the minimum dollar amount at which an expenditure is recorded as a fixed asset rather than an immediate expense?

Answer: Capitalization threshold

A capitalization threshold (or policy) sets the minimum cost above which an item is capitalized and depreciated rather than expensed.