Professional Billing

Question 1

What is the difference between the CUR_PCP_PROV_ID column in the PATIENT table and the data in the PAT_PCP table?

Answer 1

CUR_PCP_PROV_ID lists the patient’s general PCP at the time of the most recent extract and load process. PCP_PROV_ID will contain all PCP’s, current and prior, for all patients.

Question 2

Is it possible for a patient to have more than one coverage? Which table lists all the coverages that a patient has?

Answer 2

Yes, COVERAGE_MEM_LIST

Question 3

Guarantor accounts (EAR master file records) can be used for multiple patients. What table is used to find the relationship?

Answer 3

ACCT_GUAR_PAT_INFO

Question 4

You have been asked to write a report that lists each patient and their current general PCP. The report should include that patient’s name and the provider’s name. Which tables do you need? How would you link the tables together?

Answer 4

PATIENT, CLARITY_SER

Link: PATIENT.CUR_PCP_PROV_ID = CLARITY_SER.PROV_ID

Question 5

Is a detail type 1 (charge) positive or negative?

Answer 5

Positive

Question 6

Suppose a user enters a charge, posts a payment, and distributes the payment to the charge. How many records are created in TDL? Name the records.

Answer 6

4; charge, payment, charge matched to payment and, payment matched to charge.

Question 7

You have been asked to write a report that lists voids entered this month on charges that were entered in prior months. What fields would you use?

Answer 7

Find Detail Type 10 with a POST_DATE in this month and an ORIG_POST_DATE prior to this month.

Question 8

Typically, how often are aging records extracted into Clarity?

Answer 8

Monthly

Question 9

What determines if an aging record will get created in Clarity?

Answer 9

If there is a non-zero balance on the transaction

Question 10

How would you determine the age of a record based on service date? Write the formula.

Answer 10

Subtract the ORIG_SERVICE_DATE from the POST_DATE

Question 11

How would you determine the age of a record based on post date? Write the formula.

Answer 11

Limit your report to Detail Types 60 and 61. Subtract the ORIG_POST_DATE from the POST_DATE

Question 12

Where should Hyperspace users go to post a denial?

Answer 12

The Insurance Payment Posting activity.

Question 13

From what source tables do the two Explanation of Benefits views, V_ARPB_REIMBURSEMENT, and V_ARPB_REMIT_CODES, get most of their information?

Answer 13

PMT_EOB_INFO_I and PMT_EOB_INFO_II

Question 14

How can you determine which TAR records are still in a workqueue?

Answer 14

Each row in V_ARPB_CHG_WQ with no exit date is a TAR currently in a CRWQ.

Question 15

How can you tell the difference between charges that were successfully filed to ETR and those that were deleted?

Answer 15

The PRE_AR_CHG.CHARGE_STATUS_C will be 1 or 2 (filed) or 4 (deleted)

Question 16

How is it possible to get the percentage of charges performed in the past week that file cleanly (are not caught in a charge review workqueue)?

Answer 16

For all rows in PRE_AR_CHG with a SERVICE_DATE in the past week, divide the count of all rows with a CHARGE_STATUS_C of 1 (filed without review), by the count of all rows.

Question 17

Which table give you information about the activities (reviewing, deferring, deleting, transferring, resolving and error etc) performed on a TAR record?

Answer 17

V_ARPB_CHG_REVIEW_USER (could use PRE_ARCHG_HX)

Question 18

Which table gives the sum of the amount or count of the charge sessions caught by particular charge review workqueue rules?

Answer 18

F_ARPB_CR_RULE_SUM

Question 19

You have been asked to write a report that summarizes that total charges in claim edit workqueues today. How would you be able to tell if a claim is in a workqueue today?

Answer 19

CLM_EDIT_WQ_CLM.EXTRACT_DATE = today OR
CLM_EDIT_WQ_STATUS.EXTRACT_DATE = today

Question 20

How is it possible to tell how long a claim was in the claim error pool?

Answer 20

CLM_EDIT_WQ_CLM.EXTRACT_DATE - CLM_EDIT_WQ_CLM.CLM_PROCESS_DATE

Question 21

If you would like to use the information in the CE_WQ_PRODUCTIVITY table, you will need to group the user, workqueue, or date, or some combination thereof. Where does the user, workqueue, and date information come from?

Answer 21

WQ_PRODUCTIVITY table

Question 22

Describe Guarantor accounts (EAR)

Answer 22

One guarantor per guarantor account
service area specific
Patients can have multiple EARs
May be linked to multiple pt’s and coverages

Question 23

Which table contains current state demographic information for the guarantor of the account

Answer 23

ACCOUNT table.

Question 24

In Epic, a coverage is a combination of what 3 things?

Answer 24

Payor, Plan and Subscriber.

Question 25

What three tables do you need to reports on the coverage, name of relevant payor and name of the plan?

Answer 25

COVERAGE, CLARITY_EPM and CLARITY_EPP

Question 26

For information about current transactions values which tables should you use?

Answer 26

ARPB* tables. Will return only current transaction values.

Question 27

For historical information about transactions (their outstanding amounts, matching....for past week, month) what table should you use?

Answer 27

CLARITY_TDL_TRAN, this table has the most info. (includes charges, payments and adjustments. The also include distribution/matching, actions, claims and bills.)

Question 28

For aging transaction information used in aging reports which table should u use?

Answer 28

CLARITY_TDL_AGE

Question 29

Transactions in Chronicles are held in which master file?

Answer 29

ETR (example of transactions: payments, charges and adjustments)

Question 30

Define the term "action" and name the table that contains actions performed on professional billing transactions?

Answer 30

An 'action' is a way of handling a remaining balance. ARPB_TX_ACTIONS.ACTION_TYPE_C

Question 31

Whats the difference between a void and a reversal?

Answer 31

A void unmatches a transaction, and cancels out all outstanding amounts leaving a net outstanding amount of $0. A reversal also indicates a mistake, but can only be performed on a payment.

Question 32

Any transaction that has a non-zero balance will create what type of record?

Answer 32

An aging record (detail type 60 or 61) in CLARITY_TDL_AGE (only type 60 and 61 stored in this table.)

Question 33

True or False. Insurance and Self-Pay balances can be reset by the system or by the user.

Answer 33

True.

Question 34

Resolute Professional Billing offers aged AR reports based on two different approaches to aging, which are they?

Answer 34

Operational aging (dynamic aging) based on insurance and self-pay aging dates stamped on the charge. They account for changes in the aging date as transaction moves through revenue cycle. (operational perspective) Financial aging is based on the post date of the charge, depends on date that does not change as it moves through revenue cycle. (accounting appropriate)

Question 35

True or False. Electronic remittance processing loads a file from the payor in the system and matches that payments to charges automatically. If a payor does not send a file, do the payments have to be manually matched to charges.

Answer 35

True

Question 36

True or False. (Front-End Queues) Charges that trigger a warning message can be accepted without being corrected, but charges that trigger an error message must either be corrected in charge entry or tagged for further review by using the Pend to Charges button.

Answer 36

True.

Question 37

Which tables contains information for all TAR records, not just those that have been caught in a charge review workqueue?

Answer 37

PRE_AR_CHG tables.

Question 38

Workqueues are "views" of what pool?

Answer 38

Claim error pool

Question 39

True or False. The system creates FOL (Follow-up record) for each charge on a claim?

Answer 39

True. FOL= Coverage + Charge

Question 40

Name the two ways you can validate that financial data is consistent between Chronicles and Clarity?

Answer 40

Automatically - TDL Datalink validation. (should be run on daily basis) Manually compare TDL statistics report run in Chronicles and in Clarity.