Chapters 6, 7, 8, & 9

Question 1

True or False: A charge session associated with an encounter with an active PB Revenue Guardian
check will always be held in PB Charge Review workqueues.

Answer 1

False. Only if the PB Revenue Guardian check is listed as Charge Review? Yes in the service area
record and a rule is plugged into a charge review workqueue looking for active PB Revenue Guardian
checks

Question 2

Which PB Revenue Guardian Checks should be configured to route charges to PB Charge Review
Workqueues? Why?

Answer 2

PB Revenue Guardian checks should route charges to PB Charge Review workqueues for scenarios
where some charges are present for an encounter, but some might be missing. Charges can be added
to the charge session before sending claims to payers which avoids necessary payer‐related follow‐
up

Question 3

Which of the following sources of adjustments will be evaluated by adjustment/refund review
workqueues? Circle ALL that apply.
A. Adjustment Posting
B. Payment Posting
C. Credit workqueues
D. Follow‐up workqueues
E. Reimbursement contracts

Answer 3

A. Adjustment Posting, C. Credit workqueues, D. Follow‐up workqueues

Question 4

True or False: Adjustment review can be configured to require more than one user’s approval on a
single adjustment before posting.

Answer 4

True: in a cascade tiered approach, an adjustment of a higher dollar amount could go through
multiple levels of approval before the adjustment is finalized

Question 5

True or False: Every visit affected by a retroactive coverage change is sent to a workqueue for
review

Answer 5

False. The system can automatically retroadjudicate visits or automatically reject retroadjudication
for visits. When the system automatically accepts or rejects the coverage change, the visit does not
get routed to a workqueue

Question 6

What happens to the visit filing order when you accept retroadjudication for a visit, either
automatically in the profile or manually from a workqueue? Choose ALL that apply:
A. The visit is retroadjudicated, updating the filing order for the visit.
B. If the primary coverage changed then the charges from that visit will also be voided and
reposted.
C. The visit goes to a retro review workqueue.
D. The charges for the visit will always be voided and reposted when accepted

Answer 6

A. The visit is retroadjudicated, updating the filing order for the visit.
B. If the primary coverage changed then the charges from that visit will also be voided and
reposted.

Question 7

When set with Foundation System settings, what will happen to self‐pay payments that were
associated with a charge voided and reposted after Retroadjudication? Choose only ONE answer:
A. Voided
B. Transferred to a clearing account
C. Reapplied to the charge
D. Left Undistributed

Answer 7

C. Reapplied to the charge

Question 8

In order for an encounter to qualify for a Revenue Guardian Check, the encounter must do what?

Answer 8

Meet the Account Criteria
Meet the Encounter Criteria (if used)
Lack the Expected charges

Question 9

True or False: With a bucketed tiered approval
configuration, the adjustment must go through
several levels of approval before it posts to the
account.

Answer 9

False, Bucket Tier approval requires only one person.

Question 10

True or False: With a Cascade tiered approval
configuration, the adjustment must go through
several levels of approval before it posts to the
account.

Answer 10

True

Question 11

What does the abbreviation VFO stand for?

Answer 11

Visit Filing Order

Question 12

What does the abbreviation FOAL stand for?

Answer 12

Filing Order Adjustment Logic

Question 13

What is the purpose of a row in the FOAL logic?

Answer 13

Rows allow you to add configuration to determine what should happen to the visits filing order.

Question 14

What is the purpose of Retroadjutication? How is it triggered? What kind of visits is it used for?

Answer 14

Review and Resolution of changes made to an existing visits proposed filing order
Triggered: by an update to a patients filing order.
Used only for professional visits

Question 15

If no rule is associated with an automatic activity mapping line, what credit records are eligible to
qualify for that line? Choose only ONE answer.
A. All credit records will qualify for the activity mapping line
B. All credit records that meet the Days/Since criteria of that line will qualify
C. No credit records will qualify for that activity mapping line

Answer 15

B. All credit records that meet the Days/Since criteria of that line will qualify

Question 16

What section of the Credit Workqueue Profile is used to associate rules with their respective
workqueues? Choose only ONE answer.
A. Automatic Activity Mapping
B. Automatic Activity Setup
C. Reroute
D. Workqueue Routing

Answer 16

D. Workqueue Routing

Question 17

What configuration needs to be placed in the last line of the Workqueue Routing section of the
Credit Workqueue Profile? Choose only ONE answer.
A. A default credit workqueue
B. An Automatch extension
C. The Days/Since combination for the corresponding automatic activity
D. The user assigned to this workqueue

Answer 17

A. A default credit workqueue

Question 18

What is the purpose of a System Credit Workqueue?

Answer 18

System workqueues use automatic activities exclusively (end users do not work these work queues)

Question 19

What is a credit record?

Answer 19

A credit record is a temporary record created by the system whenever a payment is posted in PB that
does not fully match to an outstanding debit. This record is what is sent to a credit workqueue.