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COG230 Revenue Data Model > Hospital Accounts > Flashcards

Hospital Accounts Flashcards

1
Q

Hospital accounts are records in what master file?

A

The HAR master file and are frequently referred to as “HARs.”

(Aug. 2021, 5.4)

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2
Q

Are HARs the same in HB and PB?

A

No. HB and PB HARs store different information and have different functions in each billing system.

(Aug. 2021, 5.5)

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3
Q

What three things does a HAR provide?

A
  1. Central location to find the outstanding AR for any encounter
  2. The kind of encounter it was
  3. Who is responsible for the current balance

(Aug. 2021, 5.5)

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4
Q

Does an HB or PB HAR store more information?

A

An HB HAR.

Aug. 2021, 5.7

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5
Q

Why does HB use buckets (HLB records)?

A

To record information about the liability for various balances.

(Aug. 2021, 5.7)

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6
Q

True or False:

PB only uses buckets for presentation purposes.

A

True

Aug. 2021, 5.7

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7
Q

How long does a HAR stay active?

A

Until every charge on the account has been paid, written off, or otherwise accounted for.

(Aug. 2021, 5.8)

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8
Q

How do hospital accounts simplify the billing process?

A

By organizing transactions and other billing data in one place.

(Aug. 2021, 5.8)

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9
Q

List the six types of HARs.

A
  1. HB HARs
  2. HB SBO HARs
  3. PB SBO HARs
  4. VFO HARs
  5. Default HARs
  6. Null HARs

(Aug. 2021, 5.10)

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10
Q

What type of HARs are generated to track Hospital Billing transactions if a service area is NOT using Single Billing Office?

A

HB HARs

Aug. 2021, 5.10

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11
Q

For hospital billing, what type of HARs are generated when Single Billing Office IS turned on for that service area?

A

HB SBO HARs

Aug. 2021, 5.10

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12
Q

What is the SBO type of HB SBO HARs?

A

HB/Mixed

Aug. 2021, 5.10

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13
Q

For professional billing, what type of HARs are generated when Single Billing Office is turned on for that service area?

A

PB SBO HARs

Aug. 2021, 5.10

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14
Q

What is the SBO type of PB SBO HARs?

A

PB Only and only tracks transactions and balances for professional services.

(Aug. 2021, 5.10)

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15
Q

What PB HAR is used for service areas that do not use Single Billing Office?

A

VFO HARs
• They organize Professional Billing transactions

(Aug. 2021, 5.10)

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16
Q

True or False:

VFO HARs exist primarily to track visit-level filing order.

A

True

Aug. 2021, 5.10

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17
Q

Are PB accounts stored as records in the HAR master file?

A

Yes

Aug. 2021, 5.10

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18
Q

Where should you look first to find the guarantor or coverages used on an encounter?

A

The HAR

Aug. 2021, 5.13

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19
Q

Can one hospital account be linked to many encounters?

A

Yes

Aug. 2021, 5.13

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20
Q

What do hospital accounts store?

A

Financial details about clinical events.

Aug. 2021, 5.13

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21
Q

What do HB HARs and PB SBO HARs use bad debt and self-pay levels to track?

A

How well a guarantor is paying down each hospital account.

Aug. 2021, 5.14

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22
Q

Does the billing status of a HAR change when it’s marked with a bad debt flag?

A

No. It will remain billed until the guarantor pays or the balance is written off.

(Aug. 2021, 5.14)

23
Q

Are pre-billed bucket balances sent to bad debt when the HAR is marked as bad debt?

A

No

Aug. 2021, 5.15

24
Q

What determines the messages guarantors receive on statements and are an instrumental part of the self-pay portion of the revenue cycle?

A

Self-pay levels

Aug. 2021, 5.13

25
Q

True or False:

Self-pay levels decrease as more attempts to collect the balance occur.

A

False.

Aug. 2021, 5.15

26
Q

What can decrease the self-pay level?

A

Receiving payments from the guarantor.

Aug. 2021, 5.15

27
Q

What is the most reliable way to track the filing order for an encounter?

A

The hospital account.

Aug. 2021, 5.15

28
Q

What holds the transactions assigned to Resolute PB?

A

One of the PB HARs
• PB SBO HAR
• VFO HAR

(Aug. 2021, 5.17)

29
Q

Are PB HARs created automatically by the system?

A

Yes

Aug. 2021, 5.17

30
Q

True or False:

Hospital Billing HARs are simpler than Professional Billing HARs.

A

False

Professional Billing HARs are simpler than Hospital Billing HARs.

(Aug. 2021, 5.17)

31
Q

A HARs _______ ______ identifies the stage of the revenue cycle the HAR is currently in.

A

Billing status

Aug. 2021, 5.17

32
Q

What is the billing status of a PB HAR when it is created?

A

Closed

Aug. 2021, 5.17

33
Q

When does the billing status of a PB HAR change to Billed and become visible to end users?

A

Once PB charges are posted

Aug. 2021, 5.17

34
Q

What is the billing status of a PB HAR when it has been paid off?

A

Closed

Aug. 2021, 5.17

35
Q

What type of HAR holds the transactions assigned to Resolute HB for an admission or visit?

A

One of the HB HARs
• HB HAR
• HB SBO HAR

(Aug. 2021, 5.19)

36
Q

When is an HB HAR manually created?

A

During admission or check in for a hospital inpatient stay or hospital outpatient visit.

(Aug. 2021, 5.19)

37
Q

If a visit generates HB revenue, it needs an associated __ ___.

A

HB HAR

Aug. 2021, 5.19

38
Q

What are the four billing statues for HB HARs?

A
  1. Open
  2. DNB (Discharged Not Billed)
  3. Billed
  4. Closed

(Aug. 2021, 5.19)

39
Q

When is an HB HAR billing status Open?

A

When the patient is in the hospital.

Aug. 2021, 5.19

40
Q

Why does the billing status DNB exist?

A

To give your organization a few days to review the charges on the HAR and complete the process of coding.

(Aug. 2021, 5.19)

41
Q

What is the billing status changed to after a specified number of days have passed and all potential errors on the HAR have been addressed?

A

Billed and the process of trying to collect payment begins.

Aug. 2021, 5.20

42
Q

When is an HB HARs billing balance changed to Closed?

A

When the HAR reaches a zero balance.

Aug. 2021, 5.20

43
Q

What tracks outstanding balances based on who is responsible for them?

A

Liability buckets

Aug. 2021, 5.21

44
Q

What are the three types of liability buckets?

A
  1. Prebilled
  2. Insurance
  3. Self-pay

(Aug. 2021, 5.22)

45
Q

What does the liability bucket TYPE tell you?

A

The specific purpose it fulfills on the HAR.

Aug. 2021, 5.22

46
Q

Name that liability bucket!

Charges are pooled until appropriate information is gathered on the HAR for billing.

A

Prebilled
• There is always exactly one prebilled bucket per HAR

(Aug. 2021, 5.22)

47
Q

Name that liability bucket!

These buckets exist to hold payments from payers that don’t match any of the coverages on the HAR.

A

Undistributed
• There is always exactly one undistributed bucket per HAR

(Aug. 2021, 5.22)

48
Q

Name that liability bucket!
These buckets are numbered according to their filing order and are only created once they are needed. Each of these buckets stores the balance that coverage is responsible for and holds the payments made by that coverage for that hospital account.

A

Insurance

Aug. 2021, 5.22

49
Q

Name that liability bucket!

Balances that appear on guarantor statements.

A

Self-pay

Aug. 2021, 5.22

50
Q

List three ways to pause the revenue cycle until the error can be corrected:

A
  1. Stop Bills
  2. DNB Check
  3. Billing Indicators

(Aug. 2021, 5.24)

51
Q

True or False:
A stop bill can be placed on a HAR either by the system or manually by an end user to prevent claims and statements from being processed.

A

True

Aug. 2021, 5.24

52
Q

True or False:

DNB checks are application extensions (i.e. M code) that verify a HAR has been properly documented.

A

True

Aug. 2021, 5.24

53
Q

Can a billing indicator be used to send a HAR to a workqueue, prevent it from being outsourced to an external collection agency, or simply to indicate that a HAR needs special handling?

A

Yes

Aug. 2021, 5.24-25

COG230 Revenue Data Model (12 decks)

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