RHB100-Fundamentals Flashcards by Keegan Butts

True or False

All liability buckets are created when you initiate billing on the hospital account

Liability Buckets

False: Self-Pay and Pre-billed buckets are created when HAR is created. Primary insurance bucket is created when you initiate billint

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A hospital account must have which status to be considered for claims processing?

Liability Buckets

Billed

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A patient has a pre-billed bucket status of CLOSED, an Insurance bucket with the status of CLOSED and a Self-Pay bucket status of OUTSTANDING. What is the status of the hospital account?

Liability Buckets

Billed

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A patient has a pre-billed bucket status of CLOSED, and insurance bucket with the status of OUTSTANDING and a Self-Pay bucket with the status of CREATED. What is the hospital account status?

Liability Buckets

Billed

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Information about all benefit plans in your system are an example of what?

Chronicles

Master File

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In Epic, the information about one individual payer, like Aetna or Humana is an example of what?

Chronicles

Record

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Information about the preferred language for a patient is an example of what?

Chronicles

Item

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Information updated on the Charge HC Removal of Nail Bed specific to 10/1/2019 is an example of what?

Contact

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You work at Intergalactic Healthcare Systems. What type of record represents the entire Intergalactic Healthcare Systems organization?

Facility Structure

Facility

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The Intergalactic Healthcare System is opening a new cancer center in Weyauwega, Wisconsin. What type of record should represent the new hospital?

Facility Structure

Location

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Dan works for Intergalactic Healthcare Systems. At which level of the facility structure does he log into the system?

Facility Structure

Department

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Which of the following holds the HB charges, payments, and adjustments for any given encounter?

HB HAR

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True or False

All liability buckets are created when you Initiate Billing on the HAR

False: Only Insurance Bucket is created at Initiate Billing

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True or False

HB HARs contain transactions assigned to both Resolute Hospital Billing and Resolute Professional Billing.

False: PB Visit Accounts would contain professional billing transactions

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Which parts of the revenue cycle are affected by Single Billing Office?

Statements, Customer Service, Self-Pay Follow-Up

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Who is responsible for any balance not covered by insurance?

Guarantor

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True or False

A patient record can only be linked to one guarantor account

False

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True or False

A guarantor account is a record that holds insurance information for a patient

False

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Which ONE of the following best describes the purpose of coverage records?
1. They store information needed to send a bill for balances not covered by insurance.
2. They store information about the payer and plan attached to the patient
3. They store information about where to send appointment reminders
4. They store all of the charges, payments, and adjustments for a hospital stay

They store information about the payer and plan attached to the patient

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True or False

One coverage can have multiple subscribers

False

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What is a reason for creating a recurring series HAR?

A patient will have multiple appointments in a series spanning multiple months

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True or False

From Hospital Account for a HAR that is a part of a recurring series, you can easily access the other HARs in the series

True

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Dawn is authorized for and schedules five occupational therapy visits. Three visits take place in June, Two visits take place in July. Assuming Dawn’s insurance wants to be billed monthly, how many CSNs will be created for Dawn’s visits?

Five

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Two

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Dawn is authorized for and schedules five occupational therapy visits. Three visits take place in June, Two visits take place in July. Assuming Dawn's insurance wants to be billed monthly, how many individual claims will the insurance receive for Dawn's Visits?

Two

When are charges counted in Active AR (Accounts Receivable)

When the charges are posted to the HAR

Which activity tab on the Hospital Account provides an itemized list of hospital charges on an account?

Hosp Tx Inquiry

Where do most charges in Hospital Billing come from?

Clinical Workflows

While reviewing a charge in your workqueue you determine that the mistake originated in the clinical documentation for that encounter. In order the get the revenue posted where should the correction be made?

Update the clinical documentation (May be the job of a clinician other than yourself) since clinical documentation should be the source of truth. Updates that affect charges will flow from the clinical documentation charges

A charge is in a charge review workqueue because of a warning. What steps could you take in order to post the charge to the HAR?

Override the edit from the sidebar Correct the issue in the clinical documentation

# True or False A DNB Can be placed by a user or by the system

False: Only the system

Which Revenue Cycle processes will not take place if an HB HAR has a Stop Bill?

Initiate Billing Claims Processing Statement Processing

When can DNB Checks evaluate accounts?

Discharge Initiate Billing

Where do you generall access accounts with DNBs?

Account Workqueues

# True or False You can override a DNB check if it is an ERROR

False: You can only override Warnings

What is the name of the automated tool in Hospital Billing that reviews hospital accounts for coverage changes?

Coverage Manager

# True or False When a user Initiates Billing the system evaluates only the DNB edits the account qualified for originally

False

What tool allows users to document account notes on a HB HAR.

Account Activities

What does a Revenue Guardian Check evaluate to determine which expected charges should be on the account?

Clinical Encounter Information Hospital Account Information

Which reporting tool would you use to gather information about the CFB Days for your organization?

Dashboard

What type of information is pulled from the source account to the target account?

Charges Payments Adjustments

# True or False The status of the target account becomes Combined

False: Source account has status of Combined

From which account will a claim be generated? Target Account or Source Account

Target

# True or False Hospital accounts with claims that have claim edits are in a status of DNB or DNB (DNB Error)

False: Billed

What checks claims for errors?

The CDF

After claims have printed, what can you use to verify the correct number of claims have been printed.

The Claim Run Report

What is the status of the insurance bucket when a claim is in a claim edit workqueue?

Created

What is the status of the insurance bucket after the claim has been accepted?

Outstanding

# True or False A user can check if they have successfully fixed a claim edit by clicking Refresh Claim

True

What tool provides step-by-step instructions for how to fix claim errors?

Claim Edit Assistant

Claim edit checks are run during which process?

Claims Processing

What is the record in the system that checks claims for errors?

Claim Definition File

Claims with errors get routed to the (Blank) and are then sorted by claim edit workqueues.

Error Pool

Which of the following are considered user errors? (Choose ALL that apply) A. Missing patient address B. Missing federal tax ID in the payer record C. Subscriber ID in an incorrect pattern D. Missing patient date of birth

A,C,D

# True or False Claims can have multiple errors and be in multiple workqueues at the same time?

True

# True or False Late charge processing can and should be handled by the system automatically based on expected reimbursement contracts.

True

For a late charge situation to occur, what status must the HAR be in?

Billed

You want to send a claim to the payer that includes late charges and the original charges previously sent on a claim. Which option should you choose to accomplish this? A. Late charge claim B. Late replacement claim C. Late charge write-off D. Late charge addition

After fixing a claim issue which option should you use to immediately produce a claim to paper?

Demand Claim

# True or False When a user manually processes late charges on a hospital account the system will review those late charges, in addition the currently posted charges, in real-time and update the late charge expected reimbursement values

True

Which Workqueue Action removes an account from the active tab of the workqueue for a specific amount of time or number of days?

Defer

On which activity tab of the Hospital Account workspace can you view notes already posted to the hospital account?

History

On which activity tab of the Hospital Account workspace can you view Claim Status Codes?

Liability Buckets

Aetna has denied payment on an invoice. What part of the remittance advice explains why they denied payment?

Reason/Remit Code

When do payments in a batch affect an organization's AR?

When the batch is processed

You are posting an insurance payment and cannot find the correct invoice number in the system. Before posting to the clearing account you want tos earch by patient name instead of invoice number. What keyboard shortcut allows you to do this? A. .c B. .p C. .i D. .#

B. .p

# True or False In the manual payment posting workflow, you can process a payment posting batch that is unbalanced

False: You can close but not process an unbalanced batch

Where will you find accounts with active denial follow-up records?

Account Workqueues

# True or False An insurance bucket will turn from red to black as soon as you change the status of the follow-up record from created to any other status.

False

You are on an active denial record on Shayne's account. After researching the denial you realize that Shayne is, in fact, responsible for the remainder of the balance. Which action should you take. (Choose ALL that apply) A. Change Follow-Up Record Status to "Completed" B. Demand a new claim for Shayne C. Move the balance to the Pre-Billed Bucket D. Transfer the balance to the Self-Pay Bucket

A,D

# True or False Follow-up records are created automatically by the system based on the reason code attached to the remittance

True

# True or False A contractual variance in Epic is defined as the difference between the expected allowed reimbursement amount and the paid amount from the payer.

False: Variance is difference between expected allowed amount and the payer allowed amount

# True or False When work on a follow-up record is complete, you should delete the follow-up record

False

# True or False A Follow-Up record that has been completed can be re-opened

True

# True or False The ability to override expected reimbursement for a claim is security controlled so only certain users have access to these actions

True

Jenny recently received care at your organization. Based on your contract, Acme Insurance owes $1305.50 for Jenny's care. However, when Acme sends payment, they only send $1200. This $1200 would be defined as which of the following? A. Expected Allowed Amount B. Billed Amount C. Posted W/O D. Paid Amount

D. Paid Amount

Amber recently received care at your organization. Acme insurance sends back the following information: * Allowed: $1300 *Paid: $1250 ($50 is patient responsibility) The contract with Acme calculates the expected amount should be $1400. Based on that how much of a contractual variance exists in this scenario?

$100.00

Statements are sent at which level?

Guarantor Account

# True or False The Re-Evaluate expected reimbursement option from the bucket action button is a real-time process, meaning it will run the claim through the contract when you perform the action.

True

# True or False By logging into a specific department, a user is also logging into a specific location, parent location and service area

True

Which level of the facility structure represents separate Accounts Receivable?

Service Area

Which of the following are options for notifying guarantors of their balances? A. On-Demand balance notifications B. Statements C. MyChart notifications D. SMS notifications

A,B,C,D

What does the system do when a statement run is accepted? A. Stamps each guarantor account with a last statement date. B. Increments the sel-pay follow-up levels of the HARS C. Changes self-pay bucket status from Created to Outstanding D. Removes the statement run from the statements workspace

A,B,C,D

What information is contained in the statement run report? A. HARs included in the statement run B. Guarantor accounts included in the statement run C. List of statement hold reasons of guarantor accounts and HARs excluded from the statement run D. total self-pay balance due of all the guarantor accounts included in the statement run

B, C, D

# True or False In the foundation system all MyChart users are enrolled in paperless billing by default

True

Which of the following are options when configuring payment plan terms for a guarantor's payment plan? A. Payment Amount B. Number of payments C. Discounted amount

A,B

A guarantor is responsible for two HARs, both at self-pay follow-up level 3. Youinclude both on an activated payment plan. After you activate the payment plan, what is the self-pay follow-up level of those HARs?

Level 1

In a Single Billing Office, how many payment plans can be active for a guarantor account?

One per guarantor account

Which of the following are options a patient has in MyChart? A. Add Financial Assistance Information B. Create an estimate C. Set up a Payment Plan

A,B,C

Where in the hospital account workspace can you view information about self-pay insurance balances as well as any payments or adjustments made for all HARs belonging to the same guarantor.

Guarantor Summary

# True or False Coverage information added in MyChart does not trigger an RTE request so customer service users must re-enter all the coverage information in Registration

False

What happens when you deactivate a guarantor account? A. The deactived account can no longer be selected from the Hospital Account workspace B. The link between the patient record and deactive guarantor is removed C. All HARs linked to the deactivated account are automatically moved to a newly created guarantor account D. All HARs linked to the deactivated account remain linked

A,D

# True or False Changing the guarantor account linked to a HAR resets the self-pay follow-up level of that HAR

True

Which of the following methods of flagging something for further review is HAR-based? A. Billing Indicator B. Stop Bill C. Guarantor Status D. Contested Status

A,B,D

# True or False Updating Guarantor Status can also hold statements from processing

True

# True or False A stop bill on one HAR will stop all HARs for a given guarantor account from appearing on a statement

False

# True or False Detail bills can only include charges from a single HAR

False

# True or False Sending a Detail Bill will increase the self-pay follow-up level for a HAR

False

# True or False When payments are posted in MyChart, a user will have to distribute those payments to balances manually in Hyperspace

False

# True or False An undistributed payment is one that has not yet been posted to a guarantor account

False

If a refund needs to be given, which function within the PB credit workqueue should be performed?

Refund

You are reviewing an undistributed payment in a PB credit workqueue. You realize that the guarantor has an outstanding balance on an HB HAR and decide to mve the payment to that balance. Which function will you use to perform that task?

Distribute

You are reviewing a credit on an HB HAR in an HB account workqueue. You realize that the guarantor has an outstanding balance on another HB HAR and decide to move the payment to that balance. Where will you do this and how? A. In the workqueue, click functions and select distribute B. In the workqueue, click functions and select transfer C. In Hosp Tx Inquiry, click the post date for the credit payment and select transfer D. It is not possible to do this

On which Hospital Account tab can you view all of the HARs attached to a guarantor account with an outstanding balance.

Guar Summary

You are working the HB Self-Pay Tier 1 adjustment review workqueue. you approve a refund adjustment of $1000. What might happen after approving the adjustment? A. The adjustment posts to a hospital account as a permanent transaction B. The adjustment disappears because it was permanently deleted C. The adjustment stays in the HB Self-Pay Tier 1 adjustment review workqueue D. The adjustment is routed to another adjustment review workqueue for further review

A,D

Where can you view declined adjustments? A. In the adjustment review workqueue B. Go to Hospital Account > Tx Inquiry and select the View All Transactions checkbox C. In a charge review workqueue D. Declined adjustments are permanently deleted, you cannot view declined adjustments.