EPIC COG230 Revenue Data Model
Questions with 100% Correct Answers
Accounts Receivable Correct Answer: Outstanding money we expect to
receive in the future
Three Transaction Types: Correct Answer: Charges
Payments
Adjustments
Charges occur as a result of: Correct Answer: Performing services
Payments are a result of: Correct Answer: Receiving money
What are adjustments? Correct Answer: Anything that changes AR (Credit
Adjustments or Debit Adjustments)
An example of a credit adjustment is: Correct Answer: Contractual write-offs
An example of a debit adjustment is: Correct Answer: A refund
Debits _______ AR Correct Answer: Increase (Charges and Debit Adjustments)
Credits ________ AR Correct Answer: Decrease (Payments and Credit
Adjustments)
What is the function of a Hospital Account (HAR)? Correct Answer: Collects
transactions related to an encounter and centralizes encounters, transactions,
insurance, etc.
,Insurance coverage, is a unique combination of what 3 things? Correct Answer:
Payer
Plan
Subscriber
What is an insurance payer? Correct Answer: The insurance company
What is an insurance plan? Correct Answer: The set of benefits a patient
receives
What is an insurance subsriber? Correct Answer: The policy holder
What is a guarantor? Correct Answer: The person ultimately responsible for
payment. This could be the patient or someone else (ie. the subscriber)
Who is the insurance member? Correct Answer: The member is who the
insurance coverage is for. For example, if a subscriber has children. The children
are members of the subscriber's plan.
If a patient has multiple coverages, the order in which they are billed is called
the: Correct Answer: Filing Order
True or False
Every Hospital Account must be connected to a guarantor Correct Answer: True
True or False
Every PB Transaction must be connected to a guarantor Correct Answer: True
What are the two hospital applications used to track billing? Correct Answer: 1.
Resolute Professional Billing
, 2. Resolute Hospital Billing
What services do Professional Billing cover? Correct Answer: Services performed
by clinicians in inpatient or outpatient settings
What services do Hospital Billing cover? Correct Answer: Services and supplies
related to hospital encounters, including: medications, lab charges, imaging,
room and bed charges and more.
True or False
Hospital Billing doesn't need to achieve the level of granularity that Professional
Billing needs and does not need to match every payment to each charge
Correct Answer: True
PB transactions are stored in the ___ master file Correct Answer: ETR
HB transactions are stored in the ___ master file Correct Answer: HTR
Which system did EPIC have early on in its' development, Professional or Hospital
Billing? Correct Answer: Professional Billing
What is the purpose of a Single Billing Office (SBO)? Correct Answer: SBO is a
billing mode that combines HB and PB balances into a single guarantor
statement. Thus, creating simpler statements for easier management for
guarantors.
Diakeishaye goes to the doctor for a physical. This generates one charge for
$50. A claim is sent to Aetna, which sends a check for $35, saying there is a $5
patient portion. $10 gets written off, and the rest is sent to Diakeishaye's mother,
Leslie, who sends in a check two days later
Questions with 100% Correct Answers
Accounts Receivable Correct Answer: Outstanding money we expect to
receive in the future
Three Transaction Types: Correct Answer: Charges
Payments
Adjustments
Charges occur as a result of: Correct Answer: Performing services
Payments are a result of: Correct Answer: Receiving money
What are adjustments? Correct Answer: Anything that changes AR (Credit
Adjustments or Debit Adjustments)
An example of a credit adjustment is: Correct Answer: Contractual write-offs
An example of a debit adjustment is: Correct Answer: A refund
Debits _______ AR Correct Answer: Increase (Charges and Debit Adjustments)
Credits ________ AR Correct Answer: Decrease (Payments and Credit
Adjustments)
What is the function of a Hospital Account (HAR)? Correct Answer: Collects
transactions related to an encounter and centralizes encounters, transactions,
insurance, etc.
,Insurance coverage, is a unique combination of what 3 things? Correct Answer:
Payer
Plan
Subscriber
What is an insurance payer? Correct Answer: The insurance company
What is an insurance plan? Correct Answer: The set of benefits a patient
receives
What is an insurance subsriber? Correct Answer: The policy holder
What is a guarantor? Correct Answer: The person ultimately responsible for
payment. This could be the patient or someone else (ie. the subscriber)
Who is the insurance member? Correct Answer: The member is who the
insurance coverage is for. For example, if a subscriber has children. The children
are members of the subscriber's plan.
If a patient has multiple coverages, the order in which they are billed is called
the: Correct Answer: Filing Order
True or False
Every Hospital Account must be connected to a guarantor Correct Answer: True
True or False
Every PB Transaction must be connected to a guarantor Correct Answer: True
What are the two hospital applications used to track billing? Correct Answer: 1.
Resolute Professional Billing
, 2. Resolute Hospital Billing
What services do Professional Billing cover? Correct Answer: Services performed
by clinicians in inpatient or outpatient settings
What services do Hospital Billing cover? Correct Answer: Services and supplies
related to hospital encounters, including: medications, lab charges, imaging,
room and bed charges and more.
True or False
Hospital Billing doesn't need to achieve the level of granularity that Professional
Billing needs and does not need to match every payment to each charge
Correct Answer: True
PB transactions are stored in the ___ master file Correct Answer: ETR
HB transactions are stored in the ___ master file Correct Answer: HTR
Which system did EPIC have early on in its' development, Professional or Hospital
Billing? Correct Answer: Professional Billing
What is the purpose of a Single Billing Office (SBO)? Correct Answer: SBO is a
billing mode that combines HB and PB balances into a single guarantor
statement. Thus, creating simpler statements for easier management for
guarantors.
Diakeishaye goes to the doctor for a physical. This generates one charge for
$50. A claim is sent to Aetna, which sends a check for $35, saying there is a $5
patient portion. $10 gets written off, and the rest is sent to Diakeishaye's mother,
Leslie, who sends in a check two days later
