Introduction

Question 1

What command can be used to quickly switch between databases?

Answer 1

The USE command

Aug. 20210, 1.12

Question 2

Define accounts receivable (AR)?

Answer 2

Outstanding money we expect to receive in the future.

Aug. 2021, 1.13

Question 3

List the three types of transactions.

Answer 3

1. Charges
2. Payments
3. Adjustments

(Aug. 2021, 1.13)

Question 4

Define charges.

Answer 4

Services performed

Aug. 2021, 1.13

Question 5

Define payments.

Answer 5

Receiving money

Aug. 2021, 1.13

Question 6

Define adjustments.

Answer 6

Anything other than a charge or a payment that changes AR.

Example:
• Contractual write-offs are credit adjustments
• Refunds are debit adjustments

(Aug. 2021, 1.13)

Question 7

What do debits do to AR?

Answer 7

Increase accounts receivable

Aug. 2021, 1.13

Question 8

What do credits do to AR?

Answer 8

Decrease accounts receivable

Aug. 2021, 1.13

Question 9

What is a HAR?

Answer 9

A hospital account
• Collects transactions related to an encounter
• HARs centralize encounters, transactions, insurance, and more

(Aug. 2021, 1.13)

Question 10

Who is ultimately responsible for payment?

Answer 10

The Guarantor

Aug. 2021, 1.13

Question 11

Coverages are a unique combination of…

Answer 11

• Payer
• Plan
• Subscriber

(Aug. 2021, 1.13)

Question 12

Who is the payer?

Answer 12

The insurance company.

Aug. 2021, 1.13

Question 13

Define plan.

Answer 13

Benefits a patient receives

Aug. 2021, 1.13

Question 14

Define subscriber.

Answer 14

The policy holder.

Aug. 2021, 1.13

Question 15

What is the order in which coverages are billed called?

Answer 15

Filing order.

Aug. 2021, 1.14

Question 16

What must every hospital account and PB transaction be connected to?

Answer 16

A guarantor.

Aug. 2021, 1.14

Question 17

What are Epic’s two applications (billing systems) to track revenue?

Answer 17

1. Resolute Professional Billing
2. Resolute Hospital Billing

(Aug. 2021, 1.14)

Question 18

What does Professional Billing cover?

Answer 18

Services performed by clinicians in inpatient or outpatient settings.

(Aug. 2021, 1.14)

Question 19

What does Hospital Billing cover?

Answer 19

SERVICES and SUPPLIES related to hospital encounters (medications, lab charges, imaging, room and bed charges, etc.)

(Aug. 2021, 1.14)

Question 20

True or False:
Think of PB as tracking and reimbursing the expertise of the providers, which are commonly paid for the amount of work they do.

Answer 20

True

Aug. 2021, 1.14

Question 21

True or False:
Think of HB as tracking and reimbursing the whole hospital or lab for its work and supplies, which allows the organization to pay its employees an hourly or yearly wage.

Answer 21

True

Aug. 2021, 1.14

Question 22

What is the central pillar of the Professional Billing data model?

Answer 22

The transaction.

Aug. 2021, 1.14

Question 23

What is the connection between payments and charges called?

Answer 23

Matching

Aug. 2021, 1.14

Question 24

Does Hospital Billing need to achieve the granularity level of Professional Billing and need to match every payment to each charge?

Answer 24

No.

Hospital employees are paid an hourly wage or yearly salary that is not dependent on the number of beds they clean or the number of MRIs that are completed.

(Aug. 2021, 1.14)

Question 25

PB transactions are stored in what master file?

Answer 25

ETR | Aug. 2021, 1.15

Question 26

HB transactions are stored in what master file?

Answer 26

HTR | Aug. 2021, 1.15

Question 27

What is the benefit of a Single Billing Office (SBO)?

Answer 27

* The self-pay follow-up process includes charges from both billing systems * Simpler statements by combining the hospital and professional balances * Easier management of payments * Payments can be posted using a singe workflow (PB and HB) (Aug. 2021, 1.16)

Question 28

Does an organization have to have Resolute PB and Resolute HB in the same service area in order to use SBO functionality?

Answer 28

Yes. Statements are specific to a single guarantor account and guarantor accounts are service area specific. (Aug. 2021, 1.17)

Question 29

List the two things reporting on revenue generally center around.

Answer 29

* Transactions * Hospital Accounts (Aug. 2021, 1.18)

Question 30

Define guarantor.

Answer 30

The person (or financial entity) who is financially responsible for a patient. • Most adults will be their own guarantor • Minors will likely have a parent or legal guardian as the guarantor (Aug. 2021, 1.18)

Question 31

Are guarantor accounts unique?

Answer 31

Yes, and can be used on any encounter for which it should be financially responsible. (Aug. 2021, 1.18)

Question 32

Could a guarantor have multiple guarantor records?

Answer 32

Yes. Each guarantor account represents a single real-world guarantor, a single real-world guarantor may have a guarantor record for each capacity in which they act as guarantor. (Aug. 2021, 1.18)

Question 33

In what master file are guarantor accounts stored?

Answer 33

EAR (Epic Accounts Receivable) | Aug. 2021, 1.18

Question 34

Why are EAR records service-area specific?

Answer 34

Because guarantor accounts are service-area specific. * One guarantor account cannot be active in two service areas. * A guarantor who must be responsible for a patient's care across service areas must have two different EAR records to capture transactions in both service areas. (Aug. 2021, 1.18)

Question 35

What is a bill for payment sent to payers for the services provided to the patient called?

Answer 35

A claim. | Aug. 2021, 1.20

Question 36

What refers to the order in which claims will be sent to payers?

Answer 36

Filing order. | Aug. 2021, 1.20

Question 37

Why is it best to track filing order at the encounter or HAR level than at the patient record level?

Answer 37

Because the filing order can change across patient encounters. (Aug. 2021, 1.20)

Question 38

Define Primary Coverage.

Answer 38

The first coverage to receive the bill. | Aug. 2021, 1.20

Question 39

Why would a visit have a financial class of self-pay?

Answer 39

Because there isn't any coverage to pay for the services of the encounter; the guarantor is responsible for the entire balance of the visit. (Aug. 2021, 1.20)

Question 40

What makes it possible for Resolute PB to track filing order at the visit-level when necessary?

Answer 40

Visit Filing Order or Visit-Level Filing Order (VFO) | Aug. 2021, 1.21

Question 41

What are KPI's?

Answer 41

Key performance indicators (KPIs) are measures that organizations use to measure their successes and opportunities for improvement across clinical care and financial earnings. The Galaxy document, Overview of Key Performance Indicators, includes the name of the KPI, the definition of how that metric is calculated, and a link to the metric's entry in the metric repository. (Aug. 2021, 1.22)