RPB102 Resolute Professional Billing Fundamentals
New Update!!
Name one way you can determine where you have an error in your posting. -
ANSWER>> Run the Pending Payment Posting Batch report. click the Report button.
Explanation of Benefits - ANSWER>>Information from the payor explaining what is paid
and how to match it to the charges.
May also be known as remittance advice
Invoice Number - ANSWER>>Patients account on the CMS 1500 claim form
Patient's Account Number - ANSWER>>The number on patients account
Billed Amount - ANSWER>>Total amount charged for the service
Allowed amount - ANSWER>>Maximum reimbursement amount (payor+guarantor)
Amount from reimbursement contract
Not Allowed Amount (NAA) - ANSWER>>Writes off the amount over the allowed
amount.
Difference between billed and allowed amount
Reimbursement contract - ANSWER>>The system pulls in the allowed amount during
Insurance Payment Posting
,Paid amount - ANSWER>>The amount that has been paid
EOB codes - ANSWER>>The system automatically carries out specific actions. These
actions can transfer responsibility of a charge to the next responsible party, post
write-offs, and even flag specific payments for further investigation.
Action - ANSWER>>Deal with liability of remaining balances.
Examples are NAA or NRP
Next Responsible Party (NRP) - ANSWER>>Moves the remaining balance to the next
party in the
visit's filing order.
Recoupment - ANSWER>>If an insurance payment is applied to a charge in error, or if
a payor overpaid, you need to take back the payment
Denial - ANSWER>>Posted on the Insurance Payment Posting form
Which report would you use to view the history and details of a cash control group? -
ANSWER>>The Cash Control Group report
Which type of workqueues would the system catch claim denials that should be
reviewed? - ANSWER>>Follow-up
If a claim needs to be printed to paper right now, the __________ activity should be used.
- ANSWER>>Demand claim
If, to reopen the claim successfully, charge information needs to be refreshed, then the
_____________ function should be utilized. - ANSWER>>Correct
, If you have a denial that cannot be corrected, how do you transfer the balance to the
next payor or guarantor? - ANSWER>>NRP (Next Responsible Party)
Charge Correct - ANSWER>>Voids a charge and allows the user to edit it
before reposting, to correct a charge after it has been posted
Demand Claim - ANSWER>>• Creates a claim in real-time
• Only creates paper claims
• Bypasses error checking in the CDF
Follow-Up Workqueue Statuses - ANSWER>>R - Response has been received
D - Deferral has come due
T - Transferred to this workqueue
True or False:
Statements in Single Billing Office are generated per HAR that the guarantor
on. - ANSWER>>False: Statements are produced for guarantor accounts (a listing of all
HARs that guarantor owes on).
True or False:
The system can automatically generate statement runs. - ANSWER>>True
True or False:
Statements include both professional charges and hospital charges. - ANSWER>>True
Which of the following is a purpose of the Enterprise Statement Run Report? Choose all
that
apply.
New Update!!
Name one way you can determine where you have an error in your posting. -
ANSWER>> Run the Pending Payment Posting Batch report. click the Report button.
Explanation of Benefits - ANSWER>>Information from the payor explaining what is paid
and how to match it to the charges.
May also be known as remittance advice
Invoice Number - ANSWER>>Patients account on the CMS 1500 claim form
Patient's Account Number - ANSWER>>The number on patients account
Billed Amount - ANSWER>>Total amount charged for the service
Allowed amount - ANSWER>>Maximum reimbursement amount (payor+guarantor)
Amount from reimbursement contract
Not Allowed Amount (NAA) - ANSWER>>Writes off the amount over the allowed
amount.
Difference between billed and allowed amount
Reimbursement contract - ANSWER>>The system pulls in the allowed amount during
Insurance Payment Posting
,Paid amount - ANSWER>>The amount that has been paid
EOB codes - ANSWER>>The system automatically carries out specific actions. These
actions can transfer responsibility of a charge to the next responsible party, post
write-offs, and even flag specific payments for further investigation.
Action - ANSWER>>Deal with liability of remaining balances.
Examples are NAA or NRP
Next Responsible Party (NRP) - ANSWER>>Moves the remaining balance to the next
party in the
visit's filing order.
Recoupment - ANSWER>>If an insurance payment is applied to a charge in error, or if
a payor overpaid, you need to take back the payment
Denial - ANSWER>>Posted on the Insurance Payment Posting form
Which report would you use to view the history and details of a cash control group? -
ANSWER>>The Cash Control Group report
Which type of workqueues would the system catch claim denials that should be
reviewed? - ANSWER>>Follow-up
If a claim needs to be printed to paper right now, the __________ activity should be used.
- ANSWER>>Demand claim
If, to reopen the claim successfully, charge information needs to be refreshed, then the
_____________ function should be utilized. - ANSWER>>Correct
, If you have a denial that cannot be corrected, how do you transfer the balance to the
next payor or guarantor? - ANSWER>>NRP (Next Responsible Party)
Charge Correct - ANSWER>>Voids a charge and allows the user to edit it
before reposting, to correct a charge after it has been posted
Demand Claim - ANSWER>>• Creates a claim in real-time
• Only creates paper claims
• Bypasses error checking in the CDF
Follow-Up Workqueue Statuses - ANSWER>>R - Response has been received
D - Deferral has come due
T - Transferred to this workqueue
True or False:
Statements in Single Billing Office are generated per HAR that the guarantor
on. - ANSWER>>False: Statements are produced for guarantor accounts (a listing of all
HARs that guarantor owes on).
True or False:
The system can automatically generate statement runs. - ANSWER>>True
True or False:
Statements include both professional charges and hospital charges. - ANSWER>>True
Which of the following is a purpose of the Enterprise Statement Run Report? Choose all
that
apply.
