ABA HALM case studies
ABA HALM · Put your knowledge to work in context.
The ABA Health Law and Management (HALM) Certification is a professional credential for people who work at the intersection of health care law and health care operations - compliance officers, health care administrators, in-house counsel and paralegals, revenue cycle and contracting staff, and consultants who need fluency in both the legal framework and the business realities it governs. The exam is multiple choice and is organized around six domains: health law fundamentals and the regulatory environment; compliance, privacy, and fraud and abuse; health care operations and management; finance, reimbursement, and contracting; governance, ethics, and professional responsibility; and risk management and quality improvement. The ABA HALM case studies are 5 cases and about 2,948 words.
1The Unlicensed Provider and the Unsigned Supervision Log
A 42-clinician multi-site behavioral health group learns during a payer credentialing audit that one master's-level counselor at its satellite office has been billing independently for 14 months. The counselor holds a provisional license requiring documented weekly supervision by a fully licensed clinician, but the supervising clinician left the organization 11 months ago.
564 words, about 3 min2The Marketing Vendor's Free Lunches
A mid-sized orthopedic practice contracts with an outside marketing firm to grow its surgical volume. The firm proposes a 'patient navigation' program: it will identify candidates from public community-event sign-up lists, call them, and schedule consultations with the practice's surgeons.
584 words, about 3 min3The Denied Claim and the Missing Authorization
A 12-physician primary care group has a 1.4M annual payer mix, with 38% from one commercial payer. In Q3, that payer denies 210 claims (about 96,000) for 'no prior authorization' on advanced imaging.
604 words, about 3 min4The Capital Budget and the Aging MRI
A physician-owned multi-specialty group projects 2.1M in free cash flow next year. It faces three competing requests: (1) replace a 12-year-old MRI whose downtime has risen to 9% and which generates 1.8M in annual imaging revenue; (2) fund a new electronic health record module at 600,000 that would improve documentation and reduce denials; (3) distribute 900,000 to shareholders.
615 words, about 3 min5The Near-Miss and the Culture of Silence
A 180-bed community hospital's quality committee reviews a near-miss: a nurse caught a wrong-site medication order before administration. The order was entered by a locum tenens physician covering a weekend shift who was unfamiliar with the EHR's order-entry workflow.
581 words, about 3 min