Registration Flashcards
1
Q
True or False: The Patient is the person or entity who is ultimately financially responsible.
A
False, the patient is the person who receives the services your organization provides?
2
Q
True or False: The guarantor is the insurance company to whom an insurance claim will be sent?
A
False: The Guarantor is the person or entity who is ultimately financially responsible.
3
Q
True or False: The payor is the person who receives the services your organization provides?
A
False: The payor is the insurance company to whom an insurance claim will be sent.
4
Q
How would you access a patient’s registration information?
A
- Log into hyperspace as the access administrator.
- Launch the Registration activity for Reg/ADT
- Open your Mckinley Patients most recent contact.
5
Q
True or False: Hospital accounts consolidate the registration information active or an encounter?
A
True
6
Q
True or False: (Class) A hospital account consolidates information.
A
True, it combines a patients coverages and the guarantor Day 1 47
7
Q
True or False: Hospital accounts are HAR records in Chronicles?
A
True: Hospital accounts are HAR records in Chronicles. They are often simply called HARs. Although they are formally named hospital accounts. They are used in all healthcare contexts. It is the account ID for the clients hospital account.
8
Q
What is the master file for hospital account?
A
HAR
9
Q
What is the master file for patient?
A
EPT 25
10
Q
What is the master file for coverage?
A
CVG 25
11
Q
What is the master file for Guarantor Account?
A
EAR 25
12
Q
Resolute Professional Billing Builds HARS using what?
A
Resolute professional billing builds HARs using either Visit Filling Order (VFO) or Single Billing Office (SBO). 25
13
Q
If you need registration information for an encounter that is billed in Resolute Hospital Billing, what table should you use?
A
HSP_Account 25
14
Q
If you need registration information for an encounter that is billed in resolute professional billing and its services are use SBO, what table should you use?
A
HSP_ACCOUNT 25
15
Q
If you need registration information for an encounter that is billed in Resolute Professional Billing and its services are does not use SBO, what table do you use?
A
APRB_visits 25
16
Q
We know the following is used in clarity, but what do you use if you are reporting in caboodle?
*If you need registration information for an encounter that is billed in Resolute Hospital Billing, use HSP_ACCOUNT
*If you need registration information for an encounter that is billed in Resolute Professional Billing and its service area uses SBO, use HSP_ACCOUNT
*If you need registration information for an encounter that is billed in Resolute Professional Billing and its service area does not use SBO, use ARPB_VISITS
A
Billing Account Fact 25
17
Q
True or False: HARs were developed for Resolute hospital Billing?
A
True HARs originally were developed for resolute hospital billing to capture registration and billing data.
18
Q
True or False: Resolute Professional Billing Only uses HARs to capture registration data?
A
True
19
Q
True or False: It is best practice to identify the hospital account for a patient encounter to find its registration data.
A
True
20
Q
What Caboodle table establishes the relationship between encounters and HARs
A
BillingAccountEncounterMappingFact links EncounterFact and BillingAccountFact
21
Q
What table has the granularity of one row per HAR in caboodle, regardless of how it is generated?
A
BillingAccountFact
22
Q
What table would you use in caboodle to connect a HAR and its encounter?
A
In caboodle, you’ll use BillingAccountEncounterMappingFact to connect a HAR and its encounter.
23
Q
What table in clarity, has one row per HAR, not including VFO HARS?
A
HSP_ACCOUNT
24
Q
How would you join a HAR and encounter links in Clarity?
A
You would start from an encounter and join to its HAR with PAT_ENC_4 to PAT_ENC_HSP. 28
25
What table in Clarity, has one row per PB visit HAR?
ARPB_VISTS 27
26
The most basic database objects that will have one row for each patient encounter are?
PAT_ENC and EncounterFact 27
27
True or False: EncounterFact is looking at one row per HAR?
False, EncounterFact is looking at one row per patient encounter and it is a caboodle table.
28
TRUE or False: If you want to join HAR and Encounter links you start from HAR and join to its encounters with HSP_ACCT_PAT_CSN
True, it is valid to start from a HAR and join to its encounters with HSP_ACCT_PAT_CSN. It is equally valid to use either join direction, the decision is effectively based on whether your report started with encounters or HARs.
29
What tables would you connect to get PB visit Har?
Pat_enc_4.Pb_Visit_Har_ID 28
30
What tables would you use to connect HB HAR on a Visit?
PAT_ENC_HSP.HSP_ACCOUNT_ID 28
31
What tables would you use to connect Encounters on a HAR?
HSP_ACCT_PAT_CSN.PAT_ENC_CSN_ID 28
32
True or False: PAT_ENC is looking at one row per patient encounter?
True, PAT_ENC is a clarity table and it is looking at one row per patient encounter. 26
33
True or False: In caboodle, you will use BillingAccountEncounterMappingFact to connect to a HAR and its encounters?
True 27
34
True or False: it is not possible, in clarity to start from an encounter and joint to its HAR with PAT_ENC_4 or PAT_ENC_HSP.
False,In Clarity, it's possible to start from an encounter and join to its HAR with PAT_ENC_4 or PAT_ENC_HSP.
35
What caboodle table establishes the relationship between encounters and HARS
BillingAccountEncounterMappingFact
Links together
EncounterFact & BillingAccountFact
36
In Clarity, it's possible to start from an encounter and join to its HAR with PAT_ENC_4 or PAT_ENC_HSP. It's also valid to start from a HAR and join to its encounters, what table would you use?
HSP_ACCT_PAT_CSN
37
True or False: In Epic, each patient is represented by a unique EPT record. Patient encounters are captured as contacts on the patient record?
True 29
38
True or False: Patient Medical record numbers (MRNs) do not differ from internal IDs from the EPT master file?
False, Internal IDs are guaranteed to be to be unique by the system, but it is technically possible for different patients to have the same MRN. 29
39
How can it be possible for two patients to have the same MRN?
This could happen for organizations that assign MRN by location, or organization that have merge and include patients whose MRNs were originally assigned under different systems.29
40
Consumers will likely expect to see MRN values in reports rather than internal IDS but what do you use in clarity and caboodle?
For clarity, make sure to use the internal ID to define a relationship in Clarity. In caboodle, use the durable key to define relationships with patients.
41
What does the V_PAT_DEP_MRN view do?
Returns patients department specific MRNs.
42
If you are using caboodle, for reports with patient MRN's what would you use to define relationships?
In caboodle, use the durable key to define relationships with patients. . 29
43
What patient level database object in clarity will have the granularity of one row per patient?
Patient 29
44
What patient level database objects in caboodle have the granularity of one row per patient per date range?
Caboodle 29
45
What is it call, when an organization sends a bill to a guarantor?
A Statement.
46
Guarantor
A guarantor is the person (or. financial entity) who is financially responsible for a patient.
47
True or False: A minor will be its own guarantor?
False, a minor will likely have a parent or legal guardian as the guarantor.
48
Where is the information about a guarantor stored?
In a corresponding guarantor account (EAR Record) 31
49
True or False: A guarantor record can not be reused across resolute hospital billing and resolute professional billing?
False, a single guarantor record can be reused across Resolute Hospital Billing and Resolute Professional Billing.
50
True or False: A single real‐world guarantor may have a guarantor record for each capacity in which they act as guarantor.
Although 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.
51
What masterful would the guarantor be under?
EAR (guarantor account)
52
Who would act as the guarantor in the following situation: a College University pays for the medical treatment of volunteers for its medical research? Who does the bill go to?
College University pays for the medical treatment of volunteers for its medical research. The volunteers never see a bill because CU acts as the guarantor on their hospital accounts. CU also pays worker's compensation for employees who are injured on the job. CU would have a guarantor account with a type of Research and another with a type of Worker's Compensation. These guarantor accounts could serve multiple patients on their research or worker's compensation encounters, respectively. 31
53
a HAR and a guarantor are the same?
False, each HAR points to exactly one guarantor. One guarantor can serve many HARs. Guarantors are EAR records.
54
True or False: Can a patient use different guarantor accounts across encounters?
true, however a single HAR will only use one guarantor account. For example, a patient may use their personal/Family account for most visits but use a workers comp account for their work-related injury.
55
True or False:(In Class) Are guarantors specific to service area?
True, they are specific to service area and I sought care in service area A and then service area B I would end up with 2 guarantor accounts. 32
56
What database object has the granularity of one row per guarantor account per date range.
In Caboodle, the DBO would be GuarantorDim 32
57
What database object has the granularity of one row per guarantor account?
In Clarity, the DBO would be ACCOUNT.32
58
What are the two tables that the focus in the guarantor?
In Caboodle, GuarantorDim.
In Clarity, Account 32
59
Recall that every HAR must have one and only one guarantor, which tables list the columns that identify the guarantor on a HAR in Clarity and Caboodle?
BillingAccountFact.GuarantorDurableKey
HSP_Account.Guarantor_ID
ARPB_Visits.Guarantor_ID
60
What table connects guarantor records to patient records.
The ACCT_GUAR_PAT_INFO table. However, it doesn't enable reporting on the guarantor used in registration for specific encounters. As a result, it is usually less useful than reporting on registration data from BillingAccountFact.
61
What does the coverage (CVG record) store?
A coverage stores insurance information for a patient. each bill an organization sends to insurance is called a claim.34
62
What is a payor?
A payer is an insurance company. it is not a general term for anyone sending payments to your organization
63
What is the master file for payer records?
The EPM master file
64
What is a plan?
A plan is a set of benefits that the insurance company offers 34
65
What is the master file for plan records?
EPP master file
66
What is the subscriber?
The subscriber on a coverage is the person in whose name the insurance is issued.
67
What does epic consider coverage?
In Epic, a coverage is the unique combination of a payer, plan, and subscriber.
68
Which clarity database object greatly simplifies coverage reports
V_Coverage_Payor_Plan
69
What are members?
Members are the set of patients who would use a coverage and are stored as EPT records. 36
70
True or False: A subscriber is not a member in a coverage?
The subscriber will also be a member on the coverage if the subscriber has been seen and registered in the system.
71
Why is it important to look at effective coverage dates?
Be certain to check member-level coverage dates, as member effective coverage dates may differ from the effective dates of the coverage overall.
An example is Brian was covered through his parents insurance, but he has since turned 26 years old. the coverage remains effective for the parents but not for Brian.
72
In which database object would you find member-level effective dates.
Caboodle: EligibilityEventFact
Clarity: Coverage_Member_list
73
True or False: You can use EligibilityEventFact for all coverages?
False, EligibilityEventFact is designed strictly for managed care coverages. Do not use it to report on indemnity coverages.
74
How do member effective dates appear in columns?
Most organizations are more concern with the member effective dates on a coverage than the coverage effective dates. The member effective dates appear in COVERAGE_MEMBER_LIST as the MEMBER_EFF_FROM_DATE and MEMBER_EFF_TO_DATE columns.
75
What would it mean if MEMBER_EFF_FROM_DATE stored the beginning of last month but MEMBER_EFF_TO_DATE was null?
The coverage is currently active for the member.36
76
Explain the difference between a claim and a filing order
A claim is a bill for payment for the services provided to the patient. A filing order refers to the order in which claims will be sent to payers.
77
If there are multiple coverages what happens with the bill?
A patient may have 0 to multiple coverages for an encounter. If there are multiple coverages, the first coverage to receive the bill is the primary coverage. The second is the secondary coverage, and so on. Reports about the insurance commonly group information by the primary coverage and/or secondary coverage.
78
What happens if there is no coverage for the encounter?
If no coverage will pay for the services of the encounter, the visit is said to have a self-pay financial class and the guarantor is responsible for the entire balance of the visit.
79
What is the most reliable way to track the filing order?
The hospital account is the most reliable way to track the filing order for an encounter.
80
In Chronicles, what do HARs use to track the coverages?
In Chronicles all HARS use I HAR 300 to track the HARs coverage in their filing order.
81
How many coverages does the BillingAccountFact store in caboodle?
In Caboodle, BillingAccountFact stores the first 5 coverages.
82
In Clarity, HSP_ACCOUNT and ARPB_VISTS store how many coverages?
It only stores the primary coverage
83
How many coverages does HSP_ACCT_CVG_lIST store?
It stores all coverages for that hospital account. in this table, the line column stores the filling order. Use HSP_ACCT_CVG_LIST for the filling order for all HARS.
84
Just as ACCT_GUAR_PAT_INFO table represented the general relationship between the guarantors and patients without indicating the specific registration data for an encounter what tables represent the relationships between guarantors, patients, and coverages at only a general level?
ACCT_Coverage and PAT_ACCT_CVG tables.
85
What is a critical step in registration?
A critical step in a registration workflow is verification, which is to formally verify that all necessary information has been entered correctly.40
86
Organizations often seek to increase the lead days between the completion of verification and when patient cares beings how is this tracked?
This process is tracked by records in the VRK master file.40
87
What are the main database objects relevant to reporting on the VRK 30 (Verification Type)?
Clarity: Verification and Verification_Status_HX 42
88
What is the granularity of the Verification table?
One row per VRX record.42
89
When is it appropriate to use the VERIF_STATUS_HX?
Use the VERIF_STATUS_HX table if you need to know the verification status of a record at some point in the past and use the VERIFICATION table for most other record level details. 42
90
What is the granularity of VERIF_STATUS_HX?
One row per change to a VRX record status.
91
Epic does not automatically change a status when the current one expires, so if you need to find the verification status of a record at some point what should you do?
You need to both look at the history tables listed status at the time and check that the status has not expired by that time.
92
Where would you look if you need verification status history ?
Verification.Verif_status_C VRX 50 39
93
True or False: Verification is confirmed once?
Verification is not confirmed once and then assumed perpetually valid. Registration staff regularly update registration data prior to patient encounters to replace obsolete or inaccurate data.
94
Where would you look if you need verification for a member on a coverage? CVG 31
COVERAGE_MEMBER_LIST.MEM_VERIFICATION_ID
95
What are two tolls that an organization can use to update and maintain registration data?
An organization may allow patients to update and maintain their own registration data and thereby ease verification processes using MyChart and Welcome.
96
What clarity table is one row per VRX record.
VERIFICATION
97
True or False: Each change in registration history or called Registration History Event (RHX)
True
98
In clarity, what table has a granularity of one row per change to a VRX record status?
VERIF_STATUS_HX
99
When would you use VERIF_STATUS_HX versus VERIFICATION
Use the VERIF_STATUS_HX table if you need to know the verification status of a record at some point in the past and use VERIFICATION for most other record‐level details.
100
True or False: Epic changes the status of verification automatically?
False, Epic doesn't automatically change a status when the current one expires, so if you need to find the verification status of a record at some point in the past, you need to both look at the history table's listed status at that time and check that the status had not expired by that time. 40
101
How does Epic track registration history?
USE CLARITY
Select top 10 *
From Reg_hx
43
102
What type of master is registration history saved on?
Registration History Even (RHX) record. 43
103
Which master file tables should you avoid in registration history?
HNO
104
If you need to report on changes to registration data but the RHX master file doesn't already capture such changes, what should you do?
consider using the AUDIT_ITM tables
105
Guarantor
The guarantor is the person or entity who is ultimately financially responsible. 21
106
Coverage
A coverage (CVG record) stores insurance information for a patient. In Epic, a coverage is the unique combination of a payer, plan, and subscriber.
107
Plan
A plan is a set of benefits that the insurance company offers. Plans are records in the EPP master file. 34
108
Subscriber
The subscriber on a coverage is the person in whose name the insurance is issued. Each coverage record has exactly one subscriber. 34
109
Member
Members are the set of patients who would use a coverage and are stored as EPT records. 36
110
Effective Coverage Date
Dates that the coverage is active and provides coverage for the patient.
111
Financial Assistance Case
Cases are FNC records. Registrars and financial assistance counselors can record key information to help determine whether a patient is eligible for a financial assistance program, like the patient’s income, expenses, assets, and tax returns. 46
112
Financial Assistance Program
The financial counting program offers discounts and payment plans to self-pay patients and patients who might otherwise struggle to pay. Discount programs are records in the FNP master file. Each FNP record has rules to define which patients qualify and how the system calculates patient responsibility for qualifying accounts. 46
113
Financial Assistance Tracker
If a financial counselor believes a patient should be considered for a program, the counselor can add a tracker to the case. Trackers are FNT records that link the patient and the program 46
114
Verification
A registration workflow, which is to formally verify that all necessary information has been entered correctly.
115
How would you report on Verification?
You can use the tables Verification and Verif_Status_Hx
116
Display Current Patient Demographic information
Log into Hyperspace as an access administrator
Click on the Epic button on the top and search for Registration.
Search for a patient and select the encounter
117
How would you report patient demographic information?
PatientDim and Patient
118
Join guarantor account information to patient information.
When joining a guarantor account to a patient account, you are joining a EAR to a EPT Masterfile. In Clarity, the ACCT_GUAR_PAT_INFO table connects guarantor records to patient records.
In caboodle, I can use the following SQL statement to get the guarantor info and the patient information.
USE CDW
Select top 10 *
From patientDim
left join BillingAccountFact On BillingAccountFact.PatientDurableKey =PatientDim.DurableKey
Left Join GuarantorDim ON GuarantorDim.DurableKey=BillingAccountFact.GuarantorDurableKey
*This join won’t be great, don’t forget if you use the durable key you want to also join on iscurrent = 1. And minor, I would flip the query and start in the fact table and join to the dims.
119
Join guarantor account information to hospital account information.
USE CDW
Select top 10 *
From BillingAccountFact
Left Join GuarantorDim ON GuarantorDim.DurableKey=BillingAccountFact.GuarantorDurableKey
Same thing here on durable key
Use Clarity
Select top 10*
From account
Left Join ARPB_Visits ON ARPB_Visits.Guarantor_ID =Account.Account_ID
120
Filter on effective dates for members and coverage
When looking at members and coverages we have the coverage and members master files, which are CVG and EPT. Now if we want to find member-level effective dates.
Use Clarity
Select top 10*
From COVERAGE_MEMBER_LIST
Where MEM_EFF_TO_DATE > '01/01/2023
121
Join coverages to member information.
Here we are using two master files, the CVG and the EPT.
Select top 10 *
From COVERAGE_MEMBER_LIST
Left Join Patient ON Patient.Pat_ID=COVERAGE_MEMBER_LIST.Pat_ID
Identify a visit coverages
Select top 10 *
From CoverageDim
Left join EligibilityEventFact on EligibilityEventFact.CoverageKey=CoverageDim.CoverageKey
*I will flip this around again – start in the fact join to the dims
122
Relate financial assistance cases, programs, and trackers?
Caboodle:
FinancialAssistanceTrackerFact- stores a row for each tracker. This table also stores information about the associated program. There is no need to join to a separate table for more details on a program.
FinancialAssistanceCasesFact- Stores a row for each case.
123
Identify the type of a verification record.
Each verification has a record, this can be found in the VRX master file. Verification type is a VRX 330 item. These verification records live in chronicles and then through an ETC get put in the verification table. This can be found in the clarity table and column of VERIFICATION.VERIFICATION_TYPE_. C 40-41
124
Display verification status history
If you need to display the verification history, use VERIF_STATUS_HX. This table has one row per each status change of each verification record.
Select top 10 *
From VERIF_STATUS_HX
125
Display the effects of changes in registration history.
Epic tracks the most commonly requested items in an activity called registration history. Each change is documented as a registration history even (RHX)Record. 43
USE CLARITY
Select top 10 *
From Reg_hx
126
The difference between internal identifiers and external identifiers
Patient Medical record numbers (MRNs) differ from internal IDs from the EPT master file. Internal ID are guaranteed to be unique by the system this is Epics Pat ID. Now, the external Pat IDs are the MRNs.
127
The difference between subscribers and members
The subscriber on a coverage is the person in whose name the insurance is issued. Each coverage record has exactly one subscriber. Members are the set of patients who would use a coverage and are stored as EPT records. The subscriber is also a member on the coverage if the subscriber has been seen and registered in the system.
128
The relationship between members and patient records
Members are the set of patients who would use a coverage and are stored as EPT records.
Use Clarity
Select top 10 *
From Coverage_member_List CML
Inner join patients on CML.Pat_id=Patients.Pat_id
Use CDW
Select top 10 *
From EligibilityEventFact EEF
Left join PatientDim PD ON EEF.PatientKey =PD.PatientKey
129
How the hospital account captures registration information for a patient encounter.
Hospital accounts are HAR records in chronicles. If I am looking for patient encounter and it connected to the HAR account then I can use clarity or caboodle.
Use CDW
Select top 10 *
From BillingAccountEncounterMappingFact BA
Left join EncounterFact On BA.EncounterKey=EncounterFact.EncounterKey
Left join isn’t necessary – referential integrity
USE CLARITY
Select top 10 *
From PAT_ENC_4
Inner join HSP_ACCT_PAT_CSN on PAT_ENC_4.Pat_id = HSP_ACCT_PAT_CSN.Pat_id
