Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

COG230 Revenue Data Model > Denials > Flashcards

Denials Flashcards

1
Q

What are claims also known as?

A

Invoices

Aug. 2021, 6.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are two positive outcomes from denial reporting?

A
  1. Exposes potential areas of improvement so you can send cleaner claims the first time
  2. Used to ensure that open denials are being worked on in a timely manner

(Aug. 2021, 6.4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What has Epic released to make reporting on denials easier?

A
  • Several SlicerDicer data models
  • Two Radar dashboards
  • Denials Pulse

(Aug. 2021, 6.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the two denial strategy handbooks, available on Galaxy, that Epic has released.

A
  1. Professional Billing Denials Strategy Handbook
  2. Hospital Billing Denials Strategy Handbook

These handbooks are designed to provide Epic’s recommendations for denial management and outlines tools and processes available for this purpose.

(Aug. 2021, 6.4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the two Epic released dashboards that contain SlicerDicer components for denials?

A
  1. HB insurance
  2. PB insurance

(Aug. 2021, 6.5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Is the Denials dashboard in Pulse for both HB and PB?

A

Yes

Aug. 2021, 6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

True or False:

Denials can be applied to an entire claim or to individual service lines on the claim.

A

True

Aug. 2021, 6.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What contains the reason(s) for a denial?

A

The Explanation of Benefits (EOB)

Aug. 2021, 6.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define denial.

A

A payment of less than the allowed amount for a specific reason.

(Aug. 2021, 6.6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does your organization send a payer each time they want to get paid?

A

A claim, also called an invoice.

Aug. 2021, 6.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What contains all the services your organization wants to be paid for?

A

Claim

Aug. 2021, 6.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do claim lines contain?

A

The information the payer needs to reimburse the organization.

(Aug. 2021, 6.6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does an EOB explain?

A

The amount they will pay (or not) and why.

Aug. 2021, 6.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List the three ways a payer can respond to a claim:

A
  1. Pay it according to the contract
  2. Pay some of the services on the claim and deny others (called a partial denial or a partial payment)
  3. Deny the whole claim

(Aug. 2021, 6.6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do remittance codes provide?

A

An explanation of what is or is not being paid.

Aug. 2021, 6.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Remittance codes are a record in what master file?

A

RMC

Aug. 2021, 6.6

17
Q

In what master file are denials stored?

A

BDC

• One BDC record is created per denial remittance code

(Aug. 2021, 6.6)

18
Q

What does one BDC record represent?

A

One BDC record is created per denial remittance code.

Aug. 2021, 6.6

19
Q

Could there be more than one BDC record associated with a single denial?

A

Yes, because a single claim can be denied for more than one reason.

(Aug. 2021, 6.6)

20
Q

What are the two category lists that can help you filter for denials of different types?

A

Denial Class - an Epic-released list of classifications used for benchmarking
Denial Category - a customizable list of classifications

(Aug. 2021, 6.6-7)

21
Q

True or False:

Denial codes are mapped to denial classes.

A

True

To learn which denial codes are mapped to which denial classes, view the Denial Class Mapping spreadsheet on Galaxy.

(Aug. 2021, 6.7)

22
Q

Which billing system tracks denials at the charge level?

A

Professional Billing

When payments are distributed to charges, Resolute Professional Billing posts reason codes (or remittance codes) to explain the actions taken for each service line on the EOB.

(Aug. 2021, 6.7)

23
Q

Which billing system tracks denials at the bucket level?

A

Hospital Billing

Because buckets store payer-specific information for a hospital account, we can track the denials sent by payers and their reasons.

(Aug. 2021, 6.7)

24
Q

Denials reporting is typically done at one of three levels. List those levels.

A
  1. HAR/bucket/charge level
  2. Claim level
  3. Line level

(Aug. 2021, 6.8)

25
Q

What two things should you consider when determining the correct SlicerDicer data model for Denials reporting?

A
  1. The billing system (HB/PB)
  2. The level of detail required in the result

(Aug. 2021, 6.8)

26
Q

What Caboodle table can you use if all you need to know is which HARs have outstanding denials?

A

Table: BillingAccountFact
Column: HasOpenDenial

(Aug. 2021, 6.10)

27
Q

True or False:

Use BillingDenialLineFact to report on the service that was denied.

A

True

Get information about the procedure, providers, service dates, diagnosis, CPT code, revenue code, and line-level amounts from this table.

(Aug. 2021, 6.10-11)

28
Q

Are BDC records created for each denial reason on a PB transaction or an HB transaction?

A

Both

Aug. 2021, 6.12

29
Q

What is the granularity for a PB BDC?

A

One BDC per reason per denied charge (service lines)

= Reason Codes x Service Lines

(Aug. 2021, 6.7)

30
Q

What is the granularity for a HB BDC?

A

One BDC per reason per claim

= 1 (the claim) x Number of Reason Codes

(Aug. 2021, 6.7)

COG230 Revenue Data Model (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions