HAC Healthcare Accounting Regulatory Compliance & Auditing 3 — Questions and Answers
Question 1: A healthcare organization discovers a self-disclosed overpayment from Medicare. Under the 60-day rule, from which date does the repayment clock begin?
- The date the overpayment was received
- The date the overpayment is identified (Correct answer)
- The date the audit was initiated
- The date the compliance officer is notified
Correct 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.
Question 2: Which Medicare cost report worksheet captures a hospital's capital-related costs for PPS reimbursement purposes?
- Worksheet A
- Worksheet B
- Worksheet B-1 (Correct answer)
- Worksheet C
Correct 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.
Question 3: Under HIPAA's Breach Notification Rule, when must a covered entity notify HHS of a breach affecting 500 or more individuals?
- Within 30 days of discovery
- Without unreasonable delay and within 60 days of discovery (Correct answer)
- Within 90 days of discovery
- At the end of the calendar year in which the breach occurred
Correct 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.
Question 4: In healthcare auditing, the statistical sampling method that gives every item in a population an equal chance of selection is called:
- Stratified random sampling
- Systematic sampling
- Simple random sampling (Correct answer)
- Cluster sampling
Correct 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.
Question 5: Which federal law requires Medicare Advantage plans and Part D sponsors to have effective compliance programs with mandatory training and a compliance officer?
- 42 CFR Part 422 and Part 423 (Correct answer)
- HITECH Act
- Sarbanes-Oxley Act
- The Balanced Budget Act of 1997
Correct 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.
Question 6: A healthcare accountant is calculating the net realizable value of accounts receivable. Which adjustment must be made to gross patient service revenue?
- Add contractual adjustments and bad debt
- Subtract contractual allowances and charity care write-offs (Correct answer)
- Add government reimbursement settlements only
- Subtract only Medicare and Medicaid discounts
Correct 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.
Question 7: Which OIG tool allows healthcare providers to voluntarily disclose potential fraud before a government investigation begins, typically resulting in reduced penalties?
- Medicare Self-Referral Disclosure Protocol (SRDP)
- OIG Self-Disclosure Protocol (SDP) (Correct answer)
- Corporate Integrity Agreement (CIA)
- Compliance Advisory Opinion
Correct 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.
HAC Healthcare Accounting Regulatory Compliance & Auditing 3
A healthcare organization discovers a self-disclosed overpayment from Medicare.
Under the 60-day rule, from which date does the repayment clock begin?