HAC Healthcare Analyst Systems & Regulations 3

Question 1

A hospital's case mix index (CMI) increased from 1.42 to 1.58 over one year. What does this most likely indicate?

Accepted Answer

Average patient acuity and resource consumption increased

Answer

A higher CMI indicates the hospital is treating more complex or resource-intensive cases on average, which typically correlates with higher reimbursement under DRG-based payment.

Question 2

Under the ONC's United States Core Data for Interoperability (USCDI), which data class was added in version 2 to address social determinants of health?

Accepted Answer

Sexual Orientation and Gender Identity

Answer

USCDI v2 added Sexual Orientation and Gender Identity (SOGI) as a data class to better capture social and demographic factors affecting health equity.

Question 3

Which federal law established the National Practitioner Data Bank (NPDB)?

Accepted Answer

Health Care Quality Improvement Act of 1986

Answer

The Health Care Quality Improvement Act of 1986 established the NPDB to collect and release information about adverse actions taken against healthcare practitioners.

Question 4

In claims analytics, a 'flag' for potential duplicate billing would most likely be triggered by:

Accepted Answer

Two claims with the same patient, same date of service, same procedure code, and same provider

Answer

Duplicate billing flags are raised when identical claims—same patient, DOS, procedure, and provider—are submitted more than once, indicating potential overpayment.

Question 5

The Medicare Physician Fee Schedule uses which unit to measure relative work, practice expense, and malpractice for each CPT code?

Accepted Answer

Relative Value Units (RVUs)

Answer

The Medicare Physician Fee Schedule calculates payments by multiplying Relative Value Units (RVUs) for work, practice expense, and malpractice by a conversion factor.

(HAC) Healthcare Analyst Certification Practice Test

(HAC) Healthcare Analyst Certification Practice Test

HAC Healthcare Analyst Systems & Regulations 3