Hospital Billing

Question 1

What is the difference between a coverage and a plan?

Answer 1

A plan is a package of insurance benefits provided by a single payor. A coverage is a specific insurance plan owned by a subscriber, which can cover specific patients.

Question 2

What is the difference between a hospital account and a guarantor account?

Answer 2

Many things, but the most basic difference is that a guarantor is a party that can be responsible for charges, and a guarantor account is a guarantor acting in a certain capacity. A hospital account is a collection financial information relating to a single patient encounter or episode of care. Each hospital account must be backed by one and only one guarantor account, while a guarantor account can be back many hospital accounts.

Question 3

What is the difference between the address stored in the PATIENT table and the patient’s address stored in the HSP_ACCOUNT table?

Answer 3

The PATIENT address is current-state, while the HSP_ACCOUNT address is populated and frozen when the patient is discharged.

Question 4

Do “account class” and “account base class” refer to the same list of categories?

Answer 4

No. Account class can be expanded per your needs, but only three account base classes exist - Inpatient, Outpatient, and Emergency.

Question 5

For a paid-off hospital account, will HSP_ACCOUNT.TOT_CHGS equal zero?

Answer 5

No. TOT_ACCT_BAL will equal zero, but TOT_CHGS will still contain the total amount of charges that were ever placed on the account.

Question 6

Can HSP_ACCOUNT.DISCH_DATE_TIME be different from the date and time of discharge found in the patients chart?

Answer 6

Yes. it reflects the coded time of discharge, which can potentially differ from the clinically documented time of discharge.

Question 7

Will all delinquent hospital accounts have HSP_ACCOUNT_3.BAD_DEBT_FLAG_YN set to Y?

Answer 7

Only if your organization is using account-level bad debt.

Question 8

What is a billing indicator?

Answer 8

A facility-defined category list that can be used to mark hospital accounts.

Question 9

Why would you use HSP_ACCT_ADMIT_DX in a report instead of HSP_ACCT_DX_LIST?

Answer 9

To report on the admitting diagnoses rather than the final diagnoses coded on the account.

Question 10

Which table would you use to see the first time an account became coding complete?

Answer 10

HSP_ACCT_CDSTS_HX

Question 11

Why is having a LINE value of 1 significant for a record in the HSP_ACCT_PX_LIST table?

Answer 11

This indicates the procedure is the primary procedure on the account.

Question 12

True or False. A Prebilled and a Self-Pay bucket are created for each hospital account at the time the hospital account is created.

Answer 12

True, along with an Undistributed bucket

Question 13

True or False. Each hospital account has one Insurance bucket that holds the balance insurers are responsible for.

Answer 13

False. Not all hospital accounts have any insurance buckets at all, these aren’t created until the account is billed, and are only created if the account has insurance. Also, an account with multiple insurance coverages will have a separate insurance bucket for each coverage.

Question 14

True or False. The same bucket can appear in the V_ARHB_BKT_AGING_DETAIL view more than once.

Answer 14

True. The same bucket can appear in the view more than once, but only once per aging date.

Question 15

Which types of buckets are created when a long-stay patient is still in the hospital, but you want to begin the insurance claims process?

Answer 15

Interim Primary and Interim Secondary buckets can be created while a patient is still in-house.

Question 16

How can you report on insurance denials using the liability bucket tables?

Answer 16

You can use the HSP_BKT_ACT_HX table. Each denial is logged as a bucket action.

Question 17

What are the four transaction types stored in HSP_TRANSACTIONS?

Answer 17

Charge, payment, debit adjustment and credit adjustment

Question 18

True or False. PROC_ID in HSP_TRANSACTIONS is only populated for charge transactions.

Answer 18

False, it is populated for every transaction.

Question 19

Why would a charge have a negative amount in TX_AMOUNT?

Answer 19

A charge reversal will have a negative amount.

Question 20

What date field in HSP_TRANSACTIONS should be used if you want a revenue report that will be static (returns the same results if run later?

Answer 20

TX_POST_DATE

Question 21

Is the procedure code seen in Transaction Inquiry in Hospital Billings Account Maintenance stored in HSP_TRANSACTIONS? If so, what column is it stored in? If not, what table and column is it stored in and how do you link to it from HSP_TRANSACTIONS?

Answer 21

No, the procedure code is stored in CLARITY_EAP.PROC_CODE. Linking is from HSP_TRANSACTIONS.PROC_ID to CLARITY_EAP.PROC_ID

Question 22

If you wanted to display the payor on a denial, which field would you use?

Answer 22

HSP_BUCKET.PAYOR_ID (linked from HSP_BDC.LIABILITY_BKT_ID—–>HSP_BUCKET.BUCKET_ID). To show the payor name, link from HSP_BUCKET.PAYOR_ID to the CLARITY_EPM table and show the PAYOR_NAME field.

Question 23

True of False. Each line in the HSP_BDC table represents a denial.

Answer 23

False. BDC stands for Billings Denials and Correspondence. A line may simply represent communication with an insurance company. Look at HSP_BDC.DEN_RMK_CORR_TYP_C to identify denials versus other types of BDCs.

Question 24

What does it mean if HSP_BDC_DENIAL_DATA.LINE_ON_EOB = -1?

Answer 24

The line represents invoice-level data. Line level data for the same invoice may be stored on rows where LINE_ON_EOB>0.

Question 25

What are several examples of Account Activities that a user may perform?

Answer 25

Some examples include sending accounts to bad debt, sending letters, tackling accounts out of WQs, writing off balances, creating account notes, adding stop bills, and outsourcing accounts.

Question 26

Which kind of paymens can be associated with Account Activities self pay payments or insurance payments?

Answer 26

Self pay payments

Question 27

What is the difference between the HSP_BFH_ACTIVITY and the HSP_BFH_ACT_DATA tables?

Answer 27

The HSP_BFH_ACTIVITY table indicates when an activity was performed, on which account, and by whom. One activity can map to multiple actions; the list of actions performed is stored in the HSP_BFG_ACT_DATA table.

Question 28

What does the REPORT_DT column represent in each of the dashboard tables?

Answer 28

This is the date that the dashboard data was generated. The dashboard data is usually generated on a daily basis during the early morning hours.

Question 29

Which two base classes do the DNB Errors and Stop Bills by Owner dashboard component breakdown by?

Answer 29

Inpatient and Outpatient. Emergency is included with Outpatient.

Question 30

What are the two different types of watch list options in Watch List dashboard component?

Answer 30

There are Epic-standard watch list “checks” and custom watch list “rules”.

Question 31

Which dashboard sections show a breakdown by owning area?

Answer 31

Account Workqueue Summary, Claim Error Summary, and DNB Errors and Stop Bills by Owner.

Question 32

In Epic, a coverage is considered to be the unique combination of what three things?

Answer 32

Payor, Plan, and Subscriber.

Question 33

In what scenario would the address in the PATIENT table differ from the address in the HSP_ACCOUNT table?

Answer 33

The patients address changes after they are discharged.

Question 34

What is the difference between Account Class and Account Base Class?

Answer 34

Account Class is built by your organization; Account Base Class is built by Epic.

Question 35

True or False. To display all combined accounts, filter on HSP_ACCOUNT.ACCT_BILLSTS_HA_C= 99 [combined]

Answer 35

False, filter on COMBINE_ACCT_ID instead!

Question 36

True or False. Insurance claim information is stored in HSP_ACCOUNT.

Answer 36

False

Question 37

For a paid-off hospital account, which of the following columns in the HSP_ACCOUNT table will be equal to zero?

Answer 37

HSP_ACCOUNT.TOT_ACCT_BAL

Question 38

You notice that the discharge date in HSP_ACCOUNT.DISCH_DATE_TIME is different from the discharge date and time stored on the patients chart. What might cause this?

Answer 38

The discharge date was changed during coding.

Question 39

If LINE = 1 in a row of the HSP_ACCT_DX_LIST table, what else can we say about the row?

Answer 39

That row contains the primary diagnosis.

Question 40

Who can add a DNB check to a hospital account?

Answer 40

They can only be added by the system.

Question 41

True or False. Each hospital account can only contain the charges for a single patient (with the exception of institutional accounts)

Answer 41

True. and must be guaranteed by a single guarantor. It can however be backed by multiple insurances.

Question 42

True of False. A single hospital account may potentially be linked to multiple hospital encounters.

Answer 42

True.

Question 43

What table and columns do we need for the outstanding balance on a hospital guarantor account?

Answer 43

ACCOUNT table and sum of HB_BALANCE and TOTAL_BALANCE columns.

Question 44

The sum of the outstanding balance on all hospital accounts associated with a guarantor is found where?

Answer 44

ACCOUNT.HB_BALANCE.

Question 45

What is the name of a custom category list used to group hospital accounts by the type of visit they pertain to. Most facilities have account classes called Inpatient, outpatient, and emergency, but the list is customizable?

Answer 45

Account Class

Question 46

Define Account Base Class.

Answer 46

An Epic-released list of only three values: Inpatient, Outpatient and Emergency. All account classes must map back to one of these three base classes.

Question 47

True of False. Hospital accounts inherit the financial class of the payor of the account’s primary coverage?

Answer 47

True.

Question 48

True of False. A stop bill is placed on a hospital account either by the system of manually by an end user?

Answer 48

True

Question 49

True or False. Procedure events can be linked to one or more of the coded procedures.

Answer 49

True. This allows procedures to be logically grouped, and automatically associates the event’s information with its linked procedures. (This is big for anesthesia)

Question 50

What form allows coders to enter one or more DRGs coded for the hospital accounts, and allows them to select which code set to be used on an insurance claim?

Answer 50

Groupers form.

Question 51

Name the three types of buckets:

Answer 51

1. Prebilled Buckets: Charges that have yet to be asigned to a claim invoice or self-pay statement. Only one prebilled bucket per hospital account. Undistributed also on here.
2. Self Pay Buckets: charges processed for statements to the guarantor. Only one self-pay bucket per hospital account. Bad Debt also on here.
3. Insurance Buckets: Primary, Secondary, Interm Primary and Interim Secondary.

Question 52

Name the three types of transactions created by Hospital Billing?

Answer 52

Charges, payments and adjustments. All transactions are related to a procedure record.

Question 53

Define the transaction post date.

Answer 53

Date the transaction passes all charge or adjustment review workqueue checks and is recorded on the hospital account in hospital billing.

Question 54

True or False. Once created a transaction cannot be changed within Hospital Billing?

Answer 54

True, if a change is needed a reversal transaction is created. must balance to zero!