HFMA's CSAF 2026, Certified
Specialist Accounting and Finance
Activity-based costing (ABC) - ANSWER-Method of determining product costs using
cost drivers or activity measures, which cause indirect costs to be incurred.
Three main types of Cost standards. - ANSWER-Predetermined (Synthetic), Negotiated
(Historical), and Customized (Engineered)
Four Types of Individual Cost behaviors - ANSWER-Variable, Fixed Cost Pattern, Semi-
Variable Cost Pattern, Semi-Fixed or Stepped Variable
Three Principal Types of expense variances - ANSWER-Price, Volume, and Efficiency
The 4 Primary payment methods used in managed care - ANSWER-Fee-for-Service,
Per Diem Rate, Case Rate, Capitation
Healthcare providers should develop different modeling tools depending on - ANSWER-
the reimbursement method proposed in the contract
The general categories of provider excess loss insurance are - ANSWER-per-person,
aggregate, and carve-out.
A Strategic Plan allows organizations to - ANSWER-have a clear plan as to why they
are in business and how they can stay in business in the future.
The main types of control budgets include - ANSWER-operating, capital, and cash.
A budgeting process develops assumptions for the following: - ANSWER-Admissions,
ALOS, Expense per visit, Inflation on expense, FTE per visit, Productivity on FTE per
visit, Labor cost per FTE, Net Rev per visit
Contribution Margin - ANSWER-Difference between marginal revenue and marginal
cost.
Break-even point - ANSWER-Level of sales volume of a product producing the exact
amount of contribution margin needed to cover fixed costs.
Overhead - ANSWER-Indirect Costs
Operating budget's statistical factors include - ANSWER-Historical statistics, Historical
relationship of department volume, anticipated effects of new programs, clinical practice
patters, covered lives in global payment risk programs, changes in regulatory
,environment, technical developments, process improvements, marketing efforts,
demographic trends
The primary purpose of measuring productivity is - ANSWER-for management to
determine if resources are being used efficiently
Budget types include - ANSWER-fixed and flexible
The four budget variances used to explain by cause are - ANSWER-Volume, rate
(charged), price (of a supply), and efficiency (cost per procedure).
Three common Capital Evaluation techniques - ANSWER-Payback, Net Present Value
Method, Return on Investment
Users of ratio analysis - ANSWER-Board of Directors, Management, Health Systems
Agencies, Creditors, Employee Unions, Rate Regulators
The categories of ratios used - ANSWER-Profitability Ratios, Liquidity Ratios, Activity
Ratios, Capital Structure Ratios
Two common types of long-term debt - ANSWER-Revenue bonds and General
Obligation Bonds
Undertake debt restructuring by either retiring or reacquiring existing debt for 4 reasons
- ANSWER-Take advantage of lower interest rates, change collateral restrictions, allow
acquisition of other assets, better fit debt service requriements
Healthcare bond issues place legal obligations on - ANSWER-the borrower intended to
protect the lender against default by the borrower.
In order to use the discounted cash flow method - ANSWER-you need to know the
payment flow or payment pattern and the interest rate
Every capital investment proposal requires 4 quantifiable factors - ANSWER-Cash
Outflow, Cash Inflow, Economic Life, Opportunity Cost of funds
Three significant Investment valuation methods - ANSWER-Discounted cash flow
method, Replacement cost method, Market comparison
Two types of equity financing - ANSWER-Internal and External
In a capital lease, all of the benefits and risks of owner except title or ending (salvage
value) - ANSWER-get transferred to the lessee. The lessor recovers full price and
interest during the lease.
,An operating lease is - ANSWER-when the hospital is liable for the leasing cost;
renewal options are determined by the fair market value
Advantages of leasing - ANSWER-working capital is conserved, budgetary control, tax
benefits may be realized, project may be financed 100%, lessee has greater flexibility in
replacing equipment
Disadvantages of leasing - ANSWER-Cost of extending the lease may be more than the
actual purchase price, Interest costs are higher than debt, third parties will recognize a
full lease payment as allowable only if a true operating lease, the leasing company
frequently passes the cost of property tax to the lessors
When issuing a rating on a specific organization, a rating agency will commonly
consider the following - ANSWER-Provisions or structure of the financing, competitive
environment and market position, medical staff characteristics, management capability,
financial
Methods of a Cash budget: - ANSWER-Cash receipts and disbursements Method,
Adjusted Net Income Method, Working Capital Differential Method
Primary purposes of a cash budget: - ANSWER-Identify cash requirements and sources
for a certain period of time, control the flow of cash funds
Healthcare organizations use commercial banking services for: - ANSWER-Controlled
Disbursement Account, Depository Account, Concentration Account and Zero Balance
Account, Sweep Account
The components incorporated in a cash budget: - ANSWER-Ability of the organization
to manage overall revenue cycle, projection of costs, variability in activities that impact
both revenues and expenses, regularly recurring or periodic expenses, timing of capital
purchases
An investment policy - ANSWER-Establishes a framework to make investment
decisions and evaluate results
The returns, risks, and correlation are the primary inputs for - ANSWER-asset allocation
models
Different types of asset allocation risks are as follows: - ANSWER-maturity (liquidity)
risk, interest rate risk, credit risk, political (legal) risk, market (price) risk
Three Internal control objectives: - ANSWER-Effectiveness and efficiency of operations,
Reliability of financial reporting (external and internal), compliance with applicable laws
and regulations
, Sarbanes-Oxley established: - ANSWER-Enhanced standards for accountability and
penalties for wrongdoing.
Sarbanes-Oxley makes it so that CEOs and CFOs are responsible for: - ANSWER-
Disclosure controls, ensuring specified information (controls) is made known to them,
regular evaluations of controls with quarterly certifications
PCAOB does: - ANSWER-Register public accounting firms, establish audit standards,
inspect accounting firms, disciplinary proceedings and appropriate sanctions, PCAOB
budget.
Components of auditor's attestation report: - ANSWER-Objective, Date, Evaluation
Operational auditing is one technique available to - ANSWER-management to ensure
objectives and organizational policies are effectively carried out.
Current liabilities - ANSWER-are satisfied within a year of the balance sheet date
Examples of current liabilities: - ANSWER-Notes payable to banks, current portions of
long-term debt, accounts payable, advances from and accounts payable to third-party
payers for reimbursement settlements, refunds, deferred revenue, accrued salaries,
current portion of malpractice costs
Exemption requirements for nongovernmental not-for-profit healthcare: - ANSWER-No
inures to private shareholder, no influencing legislation, no political campaign
IRS form 990 - Return of Organization Exempt from Income Tax - ANSWER-form for
income tax under IRS section 501(a) and for non-exempt charitable trusts
Most healthcare organizations are dependent - ANSWER-on financing long-term debt
Advance refunding enables providers: - ANSWER-to restructure their long-term
liabilities, reduce interest rates, or terminate restrictive bond covenants
Revenue usually is recorded when: - ANSWER-an enrollee or the service is provided to
a patient or resident.
Donations of noncash assets that are not long-lived assets are recognized as revenue -
ANSWER-in the period received.
Donations received with no restrictions attached are reported as unrestricted support in
- ANSWER-the statement of activities.
Donor-restricted contributions may be reported as unrestricted support if - ANSWER-the
organization reports consistently from period to period and discloses its accounting
policy
Specialist Accounting and Finance
Activity-based costing (ABC) - ANSWER-Method of determining product costs using
cost drivers or activity measures, which cause indirect costs to be incurred.
Three main types of Cost standards. - ANSWER-Predetermined (Synthetic), Negotiated
(Historical), and Customized (Engineered)
Four Types of Individual Cost behaviors - ANSWER-Variable, Fixed Cost Pattern, Semi-
Variable Cost Pattern, Semi-Fixed or Stepped Variable
Three Principal Types of expense variances - ANSWER-Price, Volume, and Efficiency
The 4 Primary payment methods used in managed care - ANSWER-Fee-for-Service,
Per Diem Rate, Case Rate, Capitation
Healthcare providers should develop different modeling tools depending on - ANSWER-
the reimbursement method proposed in the contract
The general categories of provider excess loss insurance are - ANSWER-per-person,
aggregate, and carve-out.
A Strategic Plan allows organizations to - ANSWER-have a clear plan as to why they
are in business and how they can stay in business in the future.
The main types of control budgets include - ANSWER-operating, capital, and cash.
A budgeting process develops assumptions for the following: - ANSWER-Admissions,
ALOS, Expense per visit, Inflation on expense, FTE per visit, Productivity on FTE per
visit, Labor cost per FTE, Net Rev per visit
Contribution Margin - ANSWER-Difference between marginal revenue and marginal
cost.
Break-even point - ANSWER-Level of sales volume of a product producing the exact
amount of contribution margin needed to cover fixed costs.
Overhead - ANSWER-Indirect Costs
Operating budget's statistical factors include - ANSWER-Historical statistics, Historical
relationship of department volume, anticipated effects of new programs, clinical practice
patters, covered lives in global payment risk programs, changes in regulatory
,environment, technical developments, process improvements, marketing efforts,
demographic trends
The primary purpose of measuring productivity is - ANSWER-for management to
determine if resources are being used efficiently
Budget types include - ANSWER-fixed and flexible
The four budget variances used to explain by cause are - ANSWER-Volume, rate
(charged), price (of a supply), and efficiency (cost per procedure).
Three common Capital Evaluation techniques - ANSWER-Payback, Net Present Value
Method, Return on Investment
Users of ratio analysis - ANSWER-Board of Directors, Management, Health Systems
Agencies, Creditors, Employee Unions, Rate Regulators
The categories of ratios used - ANSWER-Profitability Ratios, Liquidity Ratios, Activity
Ratios, Capital Structure Ratios
Two common types of long-term debt - ANSWER-Revenue bonds and General
Obligation Bonds
Undertake debt restructuring by either retiring or reacquiring existing debt for 4 reasons
- ANSWER-Take advantage of lower interest rates, change collateral restrictions, allow
acquisition of other assets, better fit debt service requriements
Healthcare bond issues place legal obligations on - ANSWER-the borrower intended to
protect the lender against default by the borrower.
In order to use the discounted cash flow method - ANSWER-you need to know the
payment flow or payment pattern and the interest rate
Every capital investment proposal requires 4 quantifiable factors - ANSWER-Cash
Outflow, Cash Inflow, Economic Life, Opportunity Cost of funds
Three significant Investment valuation methods - ANSWER-Discounted cash flow
method, Replacement cost method, Market comparison
Two types of equity financing - ANSWER-Internal and External
In a capital lease, all of the benefits and risks of owner except title or ending (salvage
value) - ANSWER-get transferred to the lessee. The lessor recovers full price and
interest during the lease.
,An operating lease is - ANSWER-when the hospital is liable for the leasing cost;
renewal options are determined by the fair market value
Advantages of leasing - ANSWER-working capital is conserved, budgetary control, tax
benefits may be realized, project may be financed 100%, lessee has greater flexibility in
replacing equipment
Disadvantages of leasing - ANSWER-Cost of extending the lease may be more than the
actual purchase price, Interest costs are higher than debt, third parties will recognize a
full lease payment as allowable only if a true operating lease, the leasing company
frequently passes the cost of property tax to the lessors
When issuing a rating on a specific organization, a rating agency will commonly
consider the following - ANSWER-Provisions or structure of the financing, competitive
environment and market position, medical staff characteristics, management capability,
financial
Methods of a Cash budget: - ANSWER-Cash receipts and disbursements Method,
Adjusted Net Income Method, Working Capital Differential Method
Primary purposes of a cash budget: - ANSWER-Identify cash requirements and sources
for a certain period of time, control the flow of cash funds
Healthcare organizations use commercial banking services for: - ANSWER-Controlled
Disbursement Account, Depository Account, Concentration Account and Zero Balance
Account, Sweep Account
The components incorporated in a cash budget: - ANSWER-Ability of the organization
to manage overall revenue cycle, projection of costs, variability in activities that impact
both revenues and expenses, regularly recurring or periodic expenses, timing of capital
purchases
An investment policy - ANSWER-Establishes a framework to make investment
decisions and evaluate results
The returns, risks, and correlation are the primary inputs for - ANSWER-asset allocation
models
Different types of asset allocation risks are as follows: - ANSWER-maturity (liquidity)
risk, interest rate risk, credit risk, political (legal) risk, market (price) risk
Three Internal control objectives: - ANSWER-Effectiveness and efficiency of operations,
Reliability of financial reporting (external and internal), compliance with applicable laws
and regulations
, Sarbanes-Oxley established: - ANSWER-Enhanced standards for accountability and
penalties for wrongdoing.
Sarbanes-Oxley makes it so that CEOs and CFOs are responsible for: - ANSWER-
Disclosure controls, ensuring specified information (controls) is made known to them,
regular evaluations of controls with quarterly certifications
PCAOB does: - ANSWER-Register public accounting firms, establish audit standards,
inspect accounting firms, disciplinary proceedings and appropriate sanctions, PCAOB
budget.
Components of auditor's attestation report: - ANSWER-Objective, Date, Evaluation
Operational auditing is one technique available to - ANSWER-management to ensure
objectives and organizational policies are effectively carried out.
Current liabilities - ANSWER-are satisfied within a year of the balance sheet date
Examples of current liabilities: - ANSWER-Notes payable to banks, current portions of
long-term debt, accounts payable, advances from and accounts payable to third-party
payers for reimbursement settlements, refunds, deferred revenue, accrued salaries,
current portion of malpractice costs
Exemption requirements for nongovernmental not-for-profit healthcare: - ANSWER-No
inures to private shareholder, no influencing legislation, no political campaign
IRS form 990 - Return of Organization Exempt from Income Tax - ANSWER-form for
income tax under IRS section 501(a) and for non-exempt charitable trusts
Most healthcare organizations are dependent - ANSWER-on financing long-term debt
Advance refunding enables providers: - ANSWER-to restructure their long-term
liabilities, reduce interest rates, or terminate restrictive bond covenants
Revenue usually is recorded when: - ANSWER-an enrollee or the service is provided to
a patient or resident.
Donations of noncash assets that are not long-lived assets are recognized as revenue -
ANSWER-in the period received.
Donations received with no restrictions attached are reported as unrestricted support in
- ANSWER-the statement of activities.
Donor-restricted contributions may be reported as unrestricted support if - ANSWER-the
organization reports consistently from period to period and discloses its accounting
policy
