EPIC COG230 REVENUE DATA MODEL
ACTUAL EXAM LATEST UPDATE 2026
QUESTIONS AND CORRECT
ANSWERS RATED.
Accounts Receivable - ANSWERSOutstanding money we expect to receive in the future
Three Transaction Types: - ANSWERSCharges
Payments
Adjustments
Charges occur as a result of: - ANSWERSPerforming services
Payments are a result of: - ANSWERSReceiving money
What are adjustments? - ANSWERSAnything that changes AR (Credit Adjustments or
Debit Adjustments)
An example of a credit adjustment is: - ANSWERSContractual write-offs
An example of a debit adjustment is: - ANSWERSA refund
Debits _______ AR - ANSWERSIncrease (Charges and Debit Adjustments)
Credits ________ AR - ANSWERSDecrease (Payments and Credit Adjustments)
What is the function of a Hospital Account (HAR)? - ANSWERSCollects transactions
related to an encounter and centralizes encounters, transactions, insurance, etc.
Insurance coverage, is a unique combination of what 3 things? - ANSWERSPayer
Plan
Subscriber
What is an insurance payer? - ANSWERSThe insurance company
What is an insurance plan? - ANSWERSThe set of benefits a patient receives
What is an insurance subsriber? - ANSWERSThe policy holder
,What is a guarantor? - ANSWERSThe person ultimately responsible for payment. This
could be the patient or someone else (ie. the subscriber)
Who is the insurance member? - ANSWERSThe 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: -
ANSWERSFiling Order
True or False
Every Hospital Account must be connected to a guarantor - ANSWERSTrue
True or False
Every PB Transaction must be connected to a guarantor - ANSWERSTrue
What are the two hospital applications used to track billing? - ANSWERS1. Resolute
Professional Billing
2. Resolute Hospital Billing
What services do Professional Billing cover? - ANSWERSServices performed by
clinicians in inpatient or outpatient settings
What services do Hospital Billing cover? - ANSWERSServices 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 - ANSWERSTrue
PB transactions are stored in the ___ master file - ANSWERSETR
HB transactions are stored in the ___ master file - ANSWERSHTR
Which system did EPIC have early on in its' development, Professional or Hospital
Billing? - ANSWERSProfessional Billing
What is the purpose of a Single Billing Office (SBO)? - ANSWERSSBO 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
, Which transactions occurred? - ANSWERSOne charge, two payments, one credit
adjustment
Who is likely the subscriber of the coverage? - ANSWERSLeslie
Which tables contain guarantor information in Caboodle and in Clarity? -
ANSWERSClarity: ACCOUNT
Caboodle: GuarantorDim
What are the four separate guarantor balances? - ANSWERSTotal Balance
Insurance balance
Self-Pay Balance
Bad Debt
In the guarantor table (ACCOUNT), columns TOTAL_BALANCE,
INSURANCE_BALANCE, PATIENT_BALANCE and BAD_DEBT_BALANCE all refer to
which billing system (Hospital v. Professional)? - ANSWERSProfessional. This is due to
professional billing originally being the only billing type tracked
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
Which billing system is this likely being tracked in? - ANSWERSProfessional
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
Who is the guarantor? - ANSWERSLeslie
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
What are the main Clarity and Caboodle tables for Coverages? - ANSWERSClarity:
COVERAGE and V_COVERAGE_PAYOR_PLAN
Caboodle: CoverageDim
What is a claim? - ANSWERSA bill for payment sent to insurance for the services
provided to the patient
ACTUAL EXAM LATEST UPDATE 2026
QUESTIONS AND CORRECT
ANSWERS RATED.
Accounts Receivable - ANSWERSOutstanding money we expect to receive in the future
Three Transaction Types: - ANSWERSCharges
Payments
Adjustments
Charges occur as a result of: - ANSWERSPerforming services
Payments are a result of: - ANSWERSReceiving money
What are adjustments? - ANSWERSAnything that changes AR (Credit Adjustments or
Debit Adjustments)
An example of a credit adjustment is: - ANSWERSContractual write-offs
An example of a debit adjustment is: - ANSWERSA refund
Debits _______ AR - ANSWERSIncrease (Charges and Debit Adjustments)
Credits ________ AR - ANSWERSDecrease (Payments and Credit Adjustments)
What is the function of a Hospital Account (HAR)? - ANSWERSCollects transactions
related to an encounter and centralizes encounters, transactions, insurance, etc.
Insurance coverage, is a unique combination of what 3 things? - ANSWERSPayer
Plan
Subscriber
What is an insurance payer? - ANSWERSThe insurance company
What is an insurance plan? - ANSWERSThe set of benefits a patient receives
What is an insurance subsriber? - ANSWERSThe policy holder
,What is a guarantor? - ANSWERSThe person ultimately responsible for payment. This
could be the patient or someone else (ie. the subscriber)
Who is the insurance member? - ANSWERSThe 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: -
ANSWERSFiling Order
True or False
Every Hospital Account must be connected to a guarantor - ANSWERSTrue
True or False
Every PB Transaction must be connected to a guarantor - ANSWERSTrue
What are the two hospital applications used to track billing? - ANSWERS1. Resolute
Professional Billing
2. Resolute Hospital Billing
What services do Professional Billing cover? - ANSWERSServices performed by
clinicians in inpatient or outpatient settings
What services do Hospital Billing cover? - ANSWERSServices 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 - ANSWERSTrue
PB transactions are stored in the ___ master file - ANSWERSETR
HB transactions are stored in the ___ master file - ANSWERSHTR
Which system did EPIC have early on in its' development, Professional or Hospital
Billing? - ANSWERSProfessional Billing
What is the purpose of a Single Billing Office (SBO)? - ANSWERSSBO 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
, Which transactions occurred? - ANSWERSOne charge, two payments, one credit
adjustment
Who is likely the subscriber of the coverage? - ANSWERSLeslie
Which tables contain guarantor information in Caboodle and in Clarity? -
ANSWERSClarity: ACCOUNT
Caboodle: GuarantorDim
What are the four separate guarantor balances? - ANSWERSTotal Balance
Insurance balance
Self-Pay Balance
Bad Debt
In the guarantor table (ACCOUNT), columns TOTAL_BALANCE,
INSURANCE_BALANCE, PATIENT_BALANCE and BAD_DEBT_BALANCE all refer to
which billing system (Hospital v. Professional)? - ANSWERSProfessional. This is due to
professional billing originally being the only billing type tracked
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
Which billing system is this likely being tracked in? - ANSWERSProfessional
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
Who is the guarantor? - ANSWERSLeslie
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
What are the main Clarity and Caboodle tables for Coverages? - ANSWERSClarity:
COVERAGE and V_COVERAGE_PAYOR_PLAN
Caboodle: CoverageDim
What is a claim? - ANSWERSA bill for payment sent to insurance for the services
provided to the patient
