Sample Examination Questions

  1. 1.) Which of the following departments would be considered an ancillary service at an acute care hospital?
    2. a. Sleep Lab Services
  2. b. Telehealth
  3. c. Nutritional Counseling
  4. d. Medical staff services

    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?
    2. a. The hospital has had trouble in recruiting speech therapists.
    3. b. The Pharmacy is behind in mixing Total Parenteral Nutritional (TPN) orders
    4. c. Late meal delivery from Food Services
    5. d. Shortage of triage nurses

    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:
    2. a. Issuing common or preferred stock
    3. b. Seek private investors
    4. c. Negotiating a joint venture with another affiliated partner
    5. d. Building a hotel as another revenue source

    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?
    2. a. The hospital is not fully compliant with Payment Card Industry (PCI) standards.
    3. b. The bank makes an error due to the volume of small donations.
    4. c. Cash donations might be skimmed from the till.
    5. d. Dancing participants become workers compensation risks.

    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?
    2. a. Large dollar requisitions are only approved 50% of the time
    3. b. The Radiology Department only has one clerical employee who can order and receive supplies.
    4. c. The clerk who posts cash payments also takes the deposit to the bank.
    5. d. Buyers cannot receive on their purchases orders but have receiving functionality.

    6.) If a health care organization receives $1,000,000 in research grant funds, what is a requirement:
    2. a. Office of the Inspector General (OIG) annual audit
    3. b. US Department of Health and Human Services (USDHHS) performance audit
    4. c. External audit of the entity's financial statements
    5. d. A Single Audit

    7.) 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:
    2. a. Three employees have been quarantined for two weeks and did not turn in timesheets.
    3. b. Accounts Payable did not pay a large invoice timely.
    4. c. Pharmacy personnel did not enter the receipt for the last delivery of the month.
    5. d. A large credit received in the month was not applied until the following month.

    8.) An auditor is completing a dashboard review. Which of the following would help the auditor evaluate the patient access function?
    2. a. Daily patient census
    3. b. Financial profitability
    4. c. Denials based on patient demographics
    5. d. Month to date ER visits

    9.) In a large healthcare system, which function is typically part of Payroll?
    2. a. Addressing documentation regarding workers compensation for remote employee's states
    3. b. Supporting the back end of the payroll application
    4. c. Recovering incentive payments for employees who terminated before fulfilling their obligations
    5. d. Processing voluntary deductions and garnishments

    10. )Which of the following is typically referenced in a Business Continuity Plan?
    2. a. Joint Commission Study
    3. b. Community Health Needs Assessment
    4. c. Diversity and Inclusion Goals
    5. d. Hazard and Vulnerability Assessment

    11.) Which of these emerging revenue cycle system challenges most impacts a health system's profitability?
    2. a. New consumer debt rules
    3. b. Price transparency
    4. c. Back-end revenue cycle management
    5. d. High patient financial responsibility       

    12.) Healthcare providers are responsible for developing ______________ and policies and procedures regarding privacy in their practices.
    2. a. Patient hotlines
    3. b. Work around procedures
    4. c. Training Materials
    5. d. Notices of Privacy Practices

    13.) Medicare Part D is what type of insurance?
    2. a. A Medicare Advantage program managed by private insurers
    3. b. Hospital coverage available to all Medicare Beneficiaries
    4. c. Prescription drug coverage available to all Medicare Beneficiaries
    5. d. Physician coverage requiring monthly premiums

    14.) 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? 
    2. a. Physician Name and Office Location
    3. b. Physician National Provider Identifier (NPI)
    4. c. Provider Tax Identification Number (TIN) and Phone
    5. d. Physician Medicare Number and Date of Birth

    15.) 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?
    2. a. Vision statement
    3. b. Industry Regulations
    4. c. Data Analytics
    5. d. IT Support Staff

    16.) Which of the following statements is correct regarding information technology (IT) governance?
    2. a. A primary goal of IT governance is to align with organizational objectives
    3. b. IT governance is an appropriate issue for organizations at the level of the board of directors only
    4. c. IT goals should be independent of strategic goals
    5. d. IT governance requires that the Control Objectives for Information and related Technology (COBIT) framework be adopted and implemented

    17.) Which of the following is the responsibility of an information technology (IT) steering committee?
    2. a. An IT steering committee plan shows how a project will be completed, including the modules or tasks to be performed and who will perform them, the dates they should be completed, and projects costs
    4. b. An IT steering committee must develop clear specifications. Before third parties bid on a project, clear specifications must be developed, including exact descriptions and definitions of the system, explicit deadlines, and precise acceptance criteria
    6. c. An IT steering committee must assess the operations of IT using system performance measurements. Common measurement include throughput (output per unit of time), utilization (percentage of time the system is being productively used), and response time (how long it takes the system to respond)
    8. d. An IT Steering committee is a committee of senior executives to direct, review, and approve IT strategic plans, oversee major initiatives, and allocate resources.

    18.) The Enterprise Risk Management (ERM) - Integrated Framework of the Committee of Sponsoring Organizations (COSO) is best defined as:
    2. a. A process which replaces the COSO internal control framework.
    3. b. The culture, capabilities, and practices, integrated with strategy-setting and performance, that organizations rely on to manage risk in creating, preserving, and realizing value.
    4. c. A process which applies a control-based approach to an organization.
    5. d. A serial process in which one component affects only the next component.

    19.) An auditor is performing a walkthrough of a patient first facility. Which of the following is a preventive supervisory and monitoring control?
    2. a. Conducting performance reviews
    3. b. Requiring mandatory vacations
    4. c. Performing audits
    5. d. Providing hiring guidelines

    20.) 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?
    2. a. Center for Medicare and Medicaid Services (CMS)
    3. b. Drug Enforcement Agency (DEA)
    4. c. Office of Civil Rights (OCR)
    5. d. The Joint Commission (TJC)

    21.) 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?
    2. a. The Joint Commission will schedule its next inspection in four years at the closing conference.
    3. b. The hospital will receive a one-year moratorium on tracking data values for Joint Commission Measures.
    4. c. Since there were no deficiencies, the hospital will receive the certification at the closing conference.
    5. d. State regulators will accept the Joint Commission's certification and not do an inspection of their own.

    22.) A healthcare organization is required to perform a Community Health Needs Assessment (CHNA) by which of the following:
    2. a. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
    3. b. CMS Conditions of Payment
    4. c. Section 501(r)(3) of the IRS Code
    5. d. Stark and Anti-Kickback rules

    23.) Qai tam lawsuits are typically filed under:
    2. a. Physician Payment Sunshine Act
    3. b. Stark and Anti-Kickback rules
    4. c. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
    5. d. The False Claims Act

    24.) 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?
    2. a. Different prices are charged for Level IV ER visits between the FSER and the hospital.
    3. b. The FSER is not within 10 miles from the hospital.
    4. c. A Medicare patient transferred from the FSER to the hospital was billed for the FSER copayment and inpatient deductible.
    5. d. A commercial patient gets two separate bills for the physician and FSER charges.

    25.) 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?
    2. a. The hospital's most recent cost report.
    3. b. The latest CMS regulations in the Federal Register.
    4. c. Current Medicare Physician Fee Schedule Final Rule.
    5. d. The commercial third party's Medicare Advantage contract.

    26.) An auditor is performing an audit of an ambulatory surgical center (ASC).  Which of the following would warrant additional follow-up by the auditor?
    2. a. Anesthesia services are billed separately from the “packaged” service.
    3. b. Pacemaker insertion is covered as part of the ASC charge.
    4. c. The ASC uses a combination of physician and hospital billing, employing CPT and HCPCS codes.
    5. d. Medicare ASC billing is done electronically using the UB92 bill format.

    27.) 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?
    2. a. Monthly administrative write-offs.
    3. b. Discharged but not final billed charges.
    4. c. Patient refunds are paid within 30 days.
    5. d. Quarterly quality coding audits by an independent third party.

    28.) 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?
    2. a. Value-based reimbursement
    3. b. Bundled payments
    4. c. Shared savings
    5. d. Discount from billed discharges

    29.) Which of the following healthcare related governmental entities does the Centers for Medicare and Medicaid Services (CMS) have jurisdiction over?
    2. a. The Affordable Care Act
    3. b. Drug Enforcement Agency
    4. c. National Institute of Health
    5. d. The Federal Drug Administration

    30.) 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?
    2. a. Physicians receiving payments under the False Claims Act.
    3. b. CMS Conditions of Payment are met.
    4. c. Physicians not performing at least 10% of services for patients receiving services under the Affordable Care Act.
    5. d. A physician received a $500 honorarium from a manufacturer for speaking at a medical conference.

   Answer Key