Regulatory Reporting & Data Governance Flashcards
7 cards from real HAC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Regulatory Reporting & Data Governance flashcards as text
The Trusted Exchange Framework and Common Agreement (TEFCA) establishes rules for nationwide health information exchange. Which organization serves as the Recognized Coordinating Entity (RCE) under TEFCA?
Answer: The Sequoia Project
The Sequoia Project was designated as the RCE by ONC and is responsible for operationalizing TEFCA and onboarding Qualified Health Information Networks (QHINs).
In healthcare regulatory reporting, a 'data dictionary' differs from a 'business glossary' primarily because a data dictionary:
Answer: Describes technical metadata including field names, data types, and valid values for system fields
A data dictionary is a technical reference cataloging database field-level attributes, while a business glossary defines concepts in business language.
Which CMS program uses the Hierarchical Condition Category (HCC) risk adjustment model to calculate expected healthcare costs for Medicare Advantage beneficiaries?
Answer: Medicare Advantage (Part C) risk adjustment
CMS uses HCC risk scores to adjust Medicare Advantage plan payments based on the predicted health costs of enrolled beneficiaries.
A healthcare organization wants to share de-identified data for research. Under HIPAA, the 'safe harbor' de-identification method requires removal of how many specific identifiers?
Answer: 18 identifiers
HIPAA's Safe Harbor method requires removal of 18 specific types of identifiers, including names, dates finer than year, geographic subdivisions smaller than state, and more.
An analytics team notices that ED utilization reports submitted to the state differ from internal dashboards by 3%. The most likely root cause to investigate first is:
Answer: Differences in patient population filters or date-range logic between the two reporting pipelines
Discrepancies between internal and external reports most commonly stem from differing business rules, filters, or date logic applied to the same underlying data.
Under the No Surprises Act, which entity is primarily responsible for ensuring compliance with surprise billing protections in the context of data reporting to CMS?
Answer: Health plans and insurers
The No Surprises Act places primary compliance and reporting obligations on health plans and insurers to protect patients from unexpected out-of-network charges.
When implementing a Master Patient Index (MPI) to support regulatory reporting across facilities, which algorithm type is most commonly used for probabilistic record linkage?
Answer: Fellegi-Sunter probabilistic matching
The Fellegi-Sunter model is the foundational probabilistic framework for record linkage, assigning match weights based on agreement across demographic fields.