HFMA
Certified Specialist Accounting & Finance
Complete Exam Review
(With Solutions)
2026
1
,1. Case: A hospital is evaluating two service lines. Service A has high
direct margin but high fixed overhead allocation; Service B has lower
direct margin but lower incremental cost. Which metric best identifies
which service to expand to improve short‑term contribution?
- A. Full cost per case
- B. Incremental contribution margin per case
- C. Return on assets
- D. Days cash on hand
Answer: B. Incremental contribution margin per case
Rationale: Incremental contribution (revenue minus variable costs)
shows short‑term benefit of adding volume before fixed cost allocation.
2. Case: A managed care contract offers a capitated payment per
member per month (PMPM) with shared savings for quality. Which risk
does the provider assume under this arrangement?
- A. Volume risk only
- B. Financial risk for utilization and cost of care for attributed members
- C. No risk; payer bears all risk
- D. Only credentialing risk
Answer: B. Financial risk for utilization and cost of care for attributed
members
Rationale: Capitation transfers utilization and cost risk to the provider
for the fixed PMPM payment.
3. Case: During annual budget planning, leadership wants to include a
contingency for uncertain volume. Which budgeting approach best
accommodates this uncertainty?
- A. Static zero‑based budget only
- B. Flexible budget with volume‑sensitive variances and scenario
analysis
- C. Ignore volume changes and use prior year fixed budget
2
, - D. Capital budget only
Answer: B. Flexible budget with volume‑sensitive variances and
scenario analysis
Rationale: Flexible budgets adjust expense and revenue projections to
actual or forecasted volume, improving variance analysis.
4. Case: A health system plans a $25M MRI replacement financed with
tax‑exempt bonds. Which financial metric is most important to evaluate
before issuing debt?
- A. Current patient satisfaction scores
- B. Debt service coverage ratio (DSCR) and projected cash flows to
support debt service
- C. Number of MRI technologists only
- D. Square footage of the facility
Answer: B. Debt service coverage ratio (DSCR) and projected cash flows
to support debt service
Rationale: DSCR assesses ability to meet interest and principal
obligations from operating cash flows—critical for bond financing.
5. Case: A treasury manager must invest short‑term operating cash while
preserving liquidity. Which investment is most appropriate?
- A. Long‑term corporate bonds with 10‑year maturity
- B. High‑quality money market instruments or Treasury bills with
maturities matching cash needs
- C. Equity mutual funds for higher returns
- D. Illiquid private equity
Answer: B. High‑quality money market instruments or Treasury bills
with maturities matching cash needs
Rationale: Short‑term, high‑quality instruments preserve principal and
provide liquidity for operating needs.
6. Case: An internal audit finds weak segregation of duties in the
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Certified Specialist Accounting & Finance
Complete Exam Review
(With Solutions)
2026
1
,1. Case: A hospital is evaluating two service lines. Service A has high
direct margin but high fixed overhead allocation; Service B has lower
direct margin but lower incremental cost. Which metric best identifies
which service to expand to improve short‑term contribution?
- A. Full cost per case
- B. Incremental contribution margin per case
- C. Return on assets
- D. Days cash on hand
Answer: B. Incremental contribution margin per case
Rationale: Incremental contribution (revenue minus variable costs)
shows short‑term benefit of adding volume before fixed cost allocation.
2. Case: A managed care contract offers a capitated payment per
member per month (PMPM) with shared savings for quality. Which risk
does the provider assume under this arrangement?
- A. Volume risk only
- B. Financial risk for utilization and cost of care for attributed members
- C. No risk; payer bears all risk
- D. Only credentialing risk
Answer: B. Financial risk for utilization and cost of care for attributed
members
Rationale: Capitation transfers utilization and cost risk to the provider
for the fixed PMPM payment.
3. Case: During annual budget planning, leadership wants to include a
contingency for uncertain volume. Which budgeting approach best
accommodates this uncertainty?
- A. Static zero‑based budget only
- B. Flexible budget with volume‑sensitive variances and scenario
analysis
- C. Ignore volume changes and use prior year fixed budget
2
, - D. Capital budget only
Answer: B. Flexible budget with volume‑sensitive variances and
scenario analysis
Rationale: Flexible budgets adjust expense and revenue projections to
actual or forecasted volume, improving variance analysis.
4. Case: A health system plans a $25M MRI replacement financed with
tax‑exempt bonds. Which financial metric is most important to evaluate
before issuing debt?
- A. Current patient satisfaction scores
- B. Debt service coverage ratio (DSCR) and projected cash flows to
support debt service
- C. Number of MRI technologists only
- D. Square footage of the facility
Answer: B. Debt service coverage ratio (DSCR) and projected cash flows
to support debt service
Rationale: DSCR assesses ability to meet interest and principal
obligations from operating cash flows—critical for bond financing.
5. Case: A treasury manager must invest short‑term operating cash while
preserving liquidity. Which investment is most appropriate?
- A. Long‑term corporate bonds with 10‑year maturity
- B. High‑quality money market instruments or Treasury bills with
maturities matching cash needs
- C. Equity mutual funds for higher returns
- D. Illiquid private equity
Answer: B. High‑quality money market instruments or Treasury bills
with maturities matching cash needs
Rationale: Short‑term, high‑quality instruments preserve principal and
provide liquidity for operating needs.
6. Case: An internal audit finds weak segregation of duties in the
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