Introduction Flashcards
What command can be used to quickly switch between databases?
The USE command
Aug. 20210, 1.12
Define accounts receivable (AR)?
Outstanding money we expect to receive in the future.
Aug. 2021, 1.13
List the three types of transactions.
- Charges
- Payments
- Adjustments
(Aug. 2021, 1.13)
Define charges.
Services performed
Aug. 2021, 1.13
Define payments.
Receiving money
Aug. 2021, 1.13
Define adjustments.
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)
What do debits do to AR?
Increase accounts receivable
Aug. 2021, 1.13
What do credits do to AR?
Decrease accounts receivable
Aug. 2021, 1.13
What is a HAR?
A hospital account
• Collects transactions related to an encounter
• HARs centralize encounters, transactions, insurance, and more
(Aug. 2021, 1.13)
Who is ultimately responsible for payment?
The Guarantor
Aug. 2021, 1.13
Coverages are a unique combination of…
- Payer
- Plan
- Subscriber
(Aug. 2021, 1.13)
Who is the payer?
The insurance company.
Aug. 2021, 1.13
Define plan.
Benefits a patient receives
Aug. 2021, 1.13
Define subscriber.
The policy holder.
Aug. 2021, 1.13
What is the order in which coverages are billed called?
Filing order.
Aug. 2021, 1.14
What must every hospital account and PB transaction be connected to?
A guarantor.
Aug. 2021, 1.14
What are Epic’s two applications (billing systems) to track revenue?
- Resolute Professional Billing
- Resolute Hospital Billing
(Aug. 2021, 1.14)
What does Professional Billing cover?
Services performed by clinicians in inpatient or outpatient settings.
(Aug. 2021, 1.14)
What does Hospital Billing cover?
SERVICES and SUPPLIES related to hospital encounters (medications, lab charges, imaging, room and bed charges, etc.)
(Aug. 2021, 1.14)
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.
True
Aug. 2021, 1.14
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.
True
Aug. 2021, 1.14
What is the central pillar of the Professional Billing data model?
The transaction.
Aug. 2021, 1.14
What is the connection between payments and charges called?
Matching
Aug. 2021, 1.14
Does Hospital Billing need to achieve the granularity level of Professional Billing and need to match every payment to each charge?
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)
PB transactions are stored in what master file?
ETR
Aug. 2021, 1.15
HB transactions are stored in what master file?
HTR
Aug. 2021, 1.15
What is the benefit of a Single Billing Office (SBO)?
- 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)
Does an organization have to have Resolute PB and Resolute HB in the same service area in order to use SBO functionality?
Yes. Statements are specific to a single guarantor account and guarantor accounts are service area specific.
(Aug. 2021, 1.17)
List the two things reporting on revenue generally center around.
- Transactions
- Hospital Accounts
(Aug. 2021, 1.18)
Define guarantor.
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)
Are guarantor accounts unique?
Yes, and can be used on any encounter for which it should be financially responsible.
(Aug. 2021, 1.18)
Could a guarantor have multiple guarantor records?
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)
In what master file are guarantor accounts stored?
EAR (Epic Accounts Receivable)
Aug. 2021, 1.18
Why are EAR records service-area specific?
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)
What is a bill for payment sent to payers for the services provided to the patient called?
A claim.
Aug. 2021, 1.20
What refers to the order in which claims will be sent to payers?
Filing order.
Aug. 2021, 1.20
Why is it best to track filing order at the encounter or HAR level than at the patient record level?
Because the filing order can change across patient encounters.
(Aug. 2021, 1.20)
Define Primary Coverage.
The first coverage to receive the bill.
Aug. 2021, 1.20
Why would a visit have a financial class of self-pay?
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)
What makes it possible for Resolute PB to track filing order at the visit-level when necessary?
Visit Filing Order or Visit-Level Filing Order (VFO)
Aug. 2021, 1.21
What are KPI’s?
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)
