Brainscape's Knowledge GenomeTM

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


See full index

COG230 Revenue Data Model > Introduction > Flashcards

Introduction Flashcards

1
Q

What command can be used to quickly switch between databases?

A

The USE command

Aug. 20210, 1.12

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

Define accounts receivable (AR)?

A

Outstanding money we expect to receive in the future.

Aug. 2021, 1.13

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

List the three types of transactions.

A
  1. Charges
  2. Payments
  3. Adjustments

(Aug. 2021, 1.13)

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

Define charges.

A

Services performed

Aug. 2021, 1.13

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

Define payments.

A

Receiving money

Aug. 2021, 1.13

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

Define adjustments.

A

Anything other than a charge or a payment that changes AR.

Example:
• Contractual write-offs are credit adjustments
• Refunds are debit adjustments

(Aug. 2021, 1.13)

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

What do debits do to AR?

A

Increase accounts receivable

Aug. 2021, 1.13

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

What do credits do to AR?

A

Decrease accounts receivable

Aug. 2021, 1.13

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

What is a HAR?

A

A hospital account
• Collects transactions related to an encounter
• HARs centralize encounters, transactions, insurance, and more

(Aug. 2021, 1.13)

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

Who is ultimately responsible for payment?

A

The Guarantor

Aug. 2021, 1.13

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

Coverages are a unique combination of…

A
  • Payer
  • Plan
  • Subscriber

(Aug. 2021, 1.13)

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

Who is the payer?

A

The insurance company.

Aug. 2021, 1.13

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

Define plan.

A

Benefits a patient receives

Aug. 2021, 1.13

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

Define subscriber.

A

The policy holder.

Aug. 2021, 1.13

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

What is the order in which coverages are billed called?

A

Filing order.

Aug. 2021, 1.14

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

What must every hospital account and PB transaction be connected to?

A

A guarantor.

Aug. 2021, 1.14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are Epic’s two applications (billing systems) to track revenue?

A
  1. Resolute Professional Billing
  2. Resolute Hospital Billing

(Aug. 2021, 1.14)

18
Q

What does Professional Billing cover?

A

Services performed by clinicians in inpatient or outpatient settings.

(Aug. 2021, 1.14)

19
Q

What does Hospital Billing cover?

A

SERVICES and SUPPLIES related to hospital encounters (medications, lab charges, imaging, room and bed charges, etc.)

(Aug. 2021, 1.14)

20
Q

True or False:
Think of PB as tracking and reimbursing the expertise of the providers, which are commonly paid for the amount of work they do.

A

True

Aug. 2021, 1.14

21
Q

True or False:
Think of HB as tracking and reimbursing the whole hospital or lab for its work and supplies, which allows the organization to pay its employees an hourly or yearly wage.

A

True

Aug. 2021, 1.14

22
Q

What is the central pillar of the Professional Billing data model?

A

The transaction.

Aug. 2021, 1.14

23
Q

What is the connection between payments and charges called?

A

Matching

Aug. 2021, 1.14

24
Q

Does Hospital Billing need to achieve the granularity level of Professional Billing and need to match every payment to each charge?

A

No.

Hospital employees are paid an hourly wage or yearly salary that is not dependent on the number of beds they clean or the number of MRIs that are completed.

(Aug. 2021, 1.14)

25
Q

PB transactions are stored in what master file?

A

ETR

Aug. 2021, 1.15

26
Q

HB transactions are stored in what master file?

A

HTR

Aug. 2021, 1.15

27
Q

What is the benefit of a Single Billing Office (SBO)?

A
  • The self-pay follow-up process includes charges from both billing systems
  • Simpler statements by combining the hospital and professional balances
  • Easier management of payments
  • Payments can be posted using a singe workflow (PB and HB)

(Aug. 2021, 1.16)

28
Q

Does an organization have to have Resolute PB and Resolute HB in the same service area in order to use SBO functionality?

A

Yes. Statements are specific to a single guarantor account and guarantor accounts are service area specific.

(Aug. 2021, 1.17)

29
Q

List the two things reporting on revenue generally center around.

A
  • Transactions
  • Hospital Accounts

(Aug. 2021, 1.18)

30
Q

Define guarantor.

A

The person (or financial entity) who is financially responsible for a patient.
• Most adults will be their own guarantor
• Minors will likely have a parent or legal guardian as the guarantor

(Aug. 2021, 1.18)

31
Q

Are guarantor accounts unique?

A

Yes, and can be used on any encounter for which it should be financially responsible.

(Aug. 2021, 1.18)

32
Q

Could a guarantor have multiple guarantor records?

A

Yes.

Each guarantor account represents a single real-world guarantor, a single real-world guarantor may have a guarantor record for each capacity in which they act as guarantor.

(Aug. 2021, 1.18)

33
Q

In what master file are guarantor accounts stored?

A

EAR (Epic Accounts Receivable)

Aug. 2021, 1.18

34
Q

Why are EAR records service-area specific?

A

Because guarantor accounts are service-area specific.

  • One guarantor account cannot be active in two service areas.
  • A guarantor who must be responsible for a patient’s care across service areas must have two different EAR records to capture transactions in both service areas.

(Aug. 2021, 1.18)

35
Q

What is a bill for payment sent to payers for the services provided to the patient called?

A

A claim.

Aug. 2021, 1.20

36
Q

What refers to the order in which claims will be sent to payers?

A

Filing order.

Aug. 2021, 1.20

37
Q

Why is it best to track filing order at the encounter or HAR level than at the patient record level?

A

Because the filing order can change across patient encounters.

(Aug. 2021, 1.20)

38
Q

Define Primary Coverage.

A

The first coverage to receive the bill.

Aug. 2021, 1.20

39
Q

Why would a visit have a financial class of self-pay?

A

Because there isn’t any coverage to pay for the services of the encounter; the guarantor is responsible for the entire balance of the visit.

(Aug. 2021, 1.20)

40
Q

What makes it possible for Resolute PB to track filing order at the visit-level when necessary?

A

Visit Filing Order or Visit-Level Filing Order (VFO)

Aug. 2021, 1.21

41
Q

What are KPI’s?

A

Key performance indicators (KPIs) are measures that organizations use to measure their successes and opportunities for improvement across clinical care and financial earnings.

The Galaxy document, Overview of Key Performance Indicators, includes the name of the KPI, the definition of how that metric is calculated, and a link to the metric’s entry in the metric repository.

(Aug. 2021, 1.22)

COG230 Revenue Data Model (12 decks)

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