1.) Which of the following departments would be considered an ancillary service at an acute care hospital?

2.) An auditor is testing Emergency Room wait times. Wait times have increased from 1-2 hours to 10 hours over the last year. Which of the following is most likely a reason for increased wait times?

3.) An auditor works for a large not-for-profit hospital, struggling to raise capital. In order to gain access to more capital funds, which of the following would be a reasonable solution:

4.) A hospital is sponsoring a dance marathon which results in significant cash donations. The dancers and the event are staffed with volunteers. Which would be a significant risk regarding those donations?

5.) The auditor works for a hospital and is conducting an audit to review the controls in the Supply Chain function. Which would be considered a significant segregation of duties conflict in the Materials Management/Supply Chain process?

6.) An auditor is testing for proper recording of expenses at fiscal year-end. The auditor is reviewing payroll, medical supplies, and drug costs. Which of the following scenarios could result in the understatement of drug costs:

7.) An auditor is completing a dashboard review. Which of the following would help the auditor evaluate the patient access function?

8.) In a large healthcare system, which function is typically part of Payroll?

9.) Which of the following is typically referenced in a Business Continuity Plan?

10.) Which of these emerging revenue cycle system challenges most impacts a health system’s profitability?

11.) Medicare Part D is what type of insurance?

12.) The patient was seen by a specialist and the nurse was asked to provide information such as name, date of birth, medical history specially blood test results to their primary care physician. What must the nurse verify before sending a fax to the primary care physician?

13.) An auditor has been assigned to conduct an IT security review. Which of the following would the auditor expect to find in the organization’s IT security policy?

14.) Which of the following statements is correct regarding information technology (IT) governance?

15.) Which of the following is the responsibility of an information technology (IT) steering committee?

16.) The Enterprise Risk Management (ERM) – Integrated Framework of the Committee of Sponsoring Organizations (COSO) is best defined as:

17.) An auditor is performing a walkthrough of a patient first facility. Which of the following is a preventive supervisory and monitoring control?

18.) A whistleblower reported via a government hotline that two nurses at your hospital were diverting oxycodone for personal use. An internal review showed controls were not operating effectively. What governmental agency is most likely to do an investigation and assess fines?

19.) Your hospital just had the closing conference of its Joint Commission inspection with no significant deficiencies. As a result, which of the following would be a likely scenario? The Joint Commission will:

20.) A healthcare organization is required to perform a Community Health Needs Assessment (CHNA) by which of the following:

21.) Qai tam lawsuits are typically filed under:

22.) An auditor is performing an audit of the hospital’s freestanding Emergency Rooms (FSER). Which of the following would be most concerning to the auditor?

23.) An auditor is testing the reimbursement of a Hospital’s Medicare Advantage (MA) Program. Which of the following would be most useful in determining if the hospital is being reimbursed properly?

24.) An auditor is performing an audit of an ambulatory surgical center (ASC). Which of the following would warrant additional follow-up by the auditor?

25.) Which of the following would a hospital’s Patient and Financial Services track as a key performance indicator (KPI) that the department’s coding is performed timely?

26.) An auditor is testing revenue charge capture as it relates to hospital reimbursement. In which of the following reimbursement type contracts is revenue charge capture most critical to reimbursement?

27.) Which of the following healthcare related governmental entities does the Centers for Medicare and Medicaid Services (CMS) have jurisdiction over?

28.) An auditor is reviewing the hospital’s physicians’ payments received from equipment and drug manufactures under the Physician Payments Sunshine Act (PPSA) on the Centers for Medicare and Medicaid Services (CMS) website. Which scenario is the most concerning?

29.) A patient learns that their healthcare provider shared their protected health information with their family member when they had not given consent for their information to be shared. Which agency should the patient contact with their complaint?

30.) A potential new hire has a name that appears to be on the Office of Inspector General’s (OIG) Exclusion list. What should the hiring organization do before moving forward with onboarding?

31.) The auditor for a Medicare Advantage-Prescription Drug Plan is conducting a Program Integrity audit. Which of the situations below would the Centers for Medicare and Medicaid Services (CMS) consider as potential fraud indicator?

32.) Mary is a non-exempt hospital employee. She goes to the breakroom to take her 30-minute lunch break and she does not have to clock out since her company’s timekeeping system utilizes an auto-deduct feature. While on break, her supervisor stops in and asks questions about a patient for over 10 minutes. How should Mary’s timecard reflect this lunchbreak?

33.) An auditor wants to validate the propriety of travel expenses for an employee and is reviewing a department’s P-card transactions. While examining the receipts, the auditor identifies entertainment expenses for several out-of-town dinners. The attendees, business purpose and business relationship are documented, and the expense was approved by the employee’s manager. What is the next best step for this auditor?

34.) An auditor is performing a review of controlled substances and has documented the process flow and reviewed drug record documentation. Which of the following would the auditor deem as a potential issue?

35.) An auditor has been asked to inventory risk management efforts made by their organization. Which of the following efforts undertaken by the organization would be included on the list?

36.) A CAE has been asked for their Internal Audit group to be involved in the entity’s Enterprise Risk Management (ERM) program. How should they respond?

37.) A healthcare organization wants to strengthen its culture of safety. What is one of the most effective ways for this organization to measure and evaluate its culture and commitment to patient safety?

38.) The Internal Auditor is conducting fieldwork for a Locum Tenens Audit. During an interview with key leaders, management informs the Internal Auditor that they do not have Locum Tenens and that all physicians are credentialed through the credentialing process. What should the Internal Auditor do next?

39.) The Internal Auditor identified issues during a Physician Contract Compliance Audit. The auditor is ranking the risk level for each of the findings. Which issue has the highest risk level?

40.) During fieldwork, the Internal Auditor is conducting a walkthrough at a medical office building to identify areas of risk. Which of the following indicates the highest regulatory risk?

41.) Mary has been a patient of Dr. Smith for years but noticed that her out-of-pocket cost increased 150%. Who should Mary contact to obtain the rationale for the increase?

42.) After a patient has completed their visit, what revenue cycle phase includes accurately documenting medical services and communicating them to the billing office to increase recovered revenue, secure revenue integrity, and compliment the revenue cycle?

43.) An auditor needs to obtain information on their organization’s processes for requesting participation in a payor network, completing credentialing requirements, submitting documents to the payer, and signing a contract. Which revenue cycle area should they contact?

44.) A member of the hospital’s Account Receivable team is responsible for analyzing the payment received from the insurance payor to determine if there was an error causing the payment to be delayed. What is the process called if an error is reported and the claim gets directed to the clearinghouse for charge review and follow-up so the claim can be sent back to the payor for correction?

45.) Revenue cycle key performance indicators (KPIs) provide the foundation for standardization and benchmarking. The Initial denial rate as a percentage of claim volume is a trending indicator of the total population of initial denials at the claim level. What are the components for Initial denial rate as a percentage of claim dollars formula?

46.) An Internal Auditor is reviewing the controls related to goods and devices in the acute care hospital operating room. Which finding should be classified as a high risk due to regulatory compliance?

47.) An auditor is conducting a charge capture audit in an Orthopedic clinic. In order for the auditor to determine if there are any patients with missing charges, the auditor must review which of the following:

48.) A patient enrolled in a liver research study had a CT scan of the liver. The patient did not have an emergency visit. The charges were billed to a payor and not the research sponsor. What is the best documentation for the auditor to review to determine whether the charges should have been billed to the research sponsor?

49.) A patient called the scheduling department to schedule a dermatology procedure their physician ordered. What must the clinic do before the day of the appointment to ensure the patient can have the procedure?

50.) An auditor is performing a review of their hospital billing processes. What would the auditor review to determine root causes for delays in billing?

51.) What element is critical to code by professional and hospital coders regardless of the visit type?

52.) Dr. Jones is a cardiologist who performs pacemaker insertions and has requested that the hospital order the medical devices from Cardinal Company. The surgery manager asks the Compliance Officer to review Dr. Jones’ request to ensure a compliant process is set up for which regulatory requirement?

53.) The hospital emergency department would like Internal Audit to complete an EMTALA audit. What is one important piece of the regulation that the Internal Auditor should look for evidence of?

54.) The Internal Auditor is wrapping up an audit of Virtual Medicine/Telehealth. A meeting to review key findings is scheduled with the Finance Manager. Which key finding would have the most impact on lost revenue?