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RPB 204 ADMIN 2
| Question | Answer |
|---|---|
| True or False: A coverage record is a required record created at admission. | False. Coverage records are optional. |
| "True or False: HB HARs can contain transactions assigned to both Resolute Hospital Billing and Resolute Professional Billing." | False. HB HARs contain only transactions that are assigned to Resolute Hospital Billing |
| True or False:Statements are sent per hospital account. | False. Statements are sent per Guarantor |
| "Where is Single Billing Office enabled? A. Hospital System Definitions B. Professional Billing Profile C. The Charge Router Profile D. The Enterprise Billing Profile" | D. Enterprise Billing Profile |
| "True or False: Access to enterprise billing tools is granted by adding the appropriate security points to a Single Billing Office security class." | "False. Access is granted by assigning the security points to either the PB or HB security class (except when a security point impacts only one or the other - then the assignment is specific to either the PB or the HB security class)." |
| True or False: The default HAR holds both hospital and professional credit transactions. | False: The default HAR holds credit transactions only in Resolute Professional Billing. |
| What is one reason for assigning each payor to a financial class? | Reporting purposes, claims functionality can rely on financial class, grouping similar payors together |
| True or False: Benefit packages can be attached directly to a payor record. | False, benefit packages can only be attached to benefit plans. Benefit plans are then attached to payor records. |
| "True or False: If you restrict a payor or plan by service area, the payor or plan cannot be used in the service area listed." | False, if a service area is listed at the payor or plan, the payor or plan can ONLY be used in that service area |
| A benefit plan can be attached to how many payors? | One |
| What is visit filing order? | "Visit filing order is the order in which the applicable coverages will be liable for the balances incurred during a visit. A single visit can have a different filing order from the patient's previously defined filing order." |
| What is Retroadjudication? | "Retroadjudication is the automatic voiding and reposting of charges based on a change to a visit's primary coverage" |
| "True or False: Every visit affected by a retroactive coverage change is sent to a workqueue for review." | "False. The system can automatically retroadjudicate visits or automatically reject retroadjudication for visits. When the system automatically accepts or rejects the coverage change, the visit does not get routed to a workqueue." |
| "What happens when you reject retroadjudication for a visit, either automatically in the profile or manually from a workqueue?" | The visit retains the original filing order. |
| "What happens when you accept retroadjudication for a visit, either automatically in the profile or manually from a workqueue ?" | "The visit is retroadjudicated, updating the filing order for the visit. If the primary coverage changed then the charges from that visit will also be voided and reposted." |
| "What will happen to self-pay payments that were associated with a charge voided and reposted after Retroadjudication?" | Always reapplied |
| "How many procedure components can you list in one condition of a component group? " | One |
| How many conditions can be added to a component group? | Multiple |
| What is the logic between two components within a single condition of a component group? | AND |
| What is the logic between two conditions within a component group? | OR |
| "Do you have to use the automatic write off if you use reimbursement contracts? If you do use it, where can the write off occur?" | No, charge entry and claims, claims only, charge entry only |
| True or False: The amount of the reimbursement could be a percentage of a fee schedule. | TRUE |
| What is the quickest way to identify specific checks from Remittance Run Selection? | Choose the Check Mode tab, use a filter. |
| What is the purpose of loading a remittance file? | "It brings the file into the system. It also checks to make sure the file in in the proper format, checks for unknown remittance codes, and ensures the file is not a duplicate." |
| When is the Process Remit step performed for a check? | Once the check is confirmed as deposited. |
| How can you tell if a Professional Billing remittance run has processing errors? | Accept Run button is unavailable. Or, a number other than 0 listed for Processing Errors. |
| What is a load error? | "An error generated when the structure of the remittance file does not match the structure of the load routine, the file contains an unknown remittance code, or the system determines that the file is a duplicate of a file previously loaded." |
| What is the effect of accepting a run? | Posts the payments to the account, deletes the run from remittance run selection, releases the invoice locks. |
| "Which electronic remittance workqueue setting allows clean payments to enter a workqueue in addition to payments with errors?" | The Admin check box |
| True or False: A workqueue must be set to active before it can catch remittance | True. |
| True or False: A workqueue can be active in more than one service area. | False. |
| "Why is important to add a rule to a workqueue when the Admin checkbox in the details section is checked?" | "If no rule is specified, the workqueue will catch all of the remittance payments (clean and errored) for the entire service area." |
| Can default actions be overridden by end users? | Yes |
| A payment procedure code must have a code type of _________. | Custom |
| What are the two types of entities to which you can attach a cash drawer? | User and workstation |
| True or False: The default HAR stores PB insurance payments as well as guarantor payments. | TRUE |
| True or False: The default HAR holds both hospital and professional credit transactions. | False: The default HAR holds credit transactions only in Resolute Professional Billing. |
| "Where can I view professional payments while in Hospital Account Maintenance for a PB HAR? Select all that apply. A. Hosp Tx Inquiry B. Prof Inquiry C. Account Contact D. Liability bucket info" | B. Prof Inquiry. |
| True or False: There is a 1:1 ratio between a given guarantor account and a default HAR. | TRUE |
| When should you use the Oldest First post type instead of the Manual post type? | When the guarantor doesn't specify which charges should be paid with her check |
| "True or False: Previous balance post types cannot be configured; you must use the model system options." | False. Post types are completely configurable. |
| True or False: You can add or edit the list of the Post Type names that display to the end-users. | True. Post Type names are created/edited from a category list. |
| What is Distribution Method? | Distribution method is the logic that defines how a payment is split across multiple HARs. |
| Credit record rules are created in which module? | Rule Editor |
| If no rule is associated to a line in automatic activity mapping, what records apply to the line? | All records that meet the Days/Since criteria of that line will qualify. If the automatic activity mapping is set at the workqueue level then only the records in that workqueue apply. If it is set at the profile level, all records in workqueues without au |
| What section of the Credit Workqueue Profile associates rules with workqueues? | Workqueue Routing |
| What section of the Credit Workqueue Profile creates the standard reroute timeline? | Reroute |
| What should always be included on the last line of the credit workqueue routing section? | Default workqueue with no rule associated |
| What is a follow-up record? | Combination of a charge transaction and its assigned coverage |
| What are the options in the Group by field in Follow-up Workqueue Maintenance? | Transaction, Invoice, Visit, Account |
| "If you want records to automatically defer for 10 days for Aetna, and for 25 days for all other payors, how would you configure this?" | "In the Profile, make a rule for payor is Aetna, enter it into line 1 of the Automatic Deferral section with days = 10. Then, on line 2, no rule, 25 days." |
| "If there are multiple rules set up with different numbers of days to defer in the profile, how does the system determine the number of days to defer the record?" | It looks at the rules from the top down and applies them in that order. |
| "What is the difference between setting up the Automatic Deferral section of the profile and specifying an Automatic Activity of Defer in follow-up workqueue maintenance?" | "Automatic Deferral in the profile can happen upon initial claim or resubmitted claim and happens as soon asthe follow-up record is created. The deferred record appears on the System Deferred tab. An automatic activity happens once the record hits the app |
| "True or False: Application reports are always run in real-time using up-to-the-minute data from a production environment." | False. Some larger application reports must be batch scheduled to minimize the strain on system resources. |
| What is a situation when a Clarity report would likely be preferable to an application report? | You need a report that accumulates and analyzes specific information over the last 5 years. |
| "True or False: The Report Repository can be accessed from the text side of Resolute Professional Billing." | False. The Report Repository is only accessed from Epic's UserWeb. |
| "True or False: In Single Billing Office, the enterprise statement will always be a guarantor level statement." | True. All statements in Single Billing Office are guarantor level. |
| "Which of the following statements best describes Drop Cycle statement processing? A. Guarantor statement prints immediately after every visit with a self-pay liability. B. Guarantor is eligible for a statement as soon as self-pay liability exists. | B |
| "True or False: It is possible to have the system automatically generate a detail bill first and 7 days later generate a statement." | TRUE |
| "True or False: When using Single Billing Office, it is optional to use Enterprise Statement Processing?" | FALSE |
| "On which form within a workqueue can you set up columns that will appear in the workqueue to ensure that the person working each queue can easily view data that pertains to the queue? A. General Settings B. Access & Ownership C. Column Configuration" | C. Column Configuration |
| "Under what circumstance would you want to create a routing rule? (Select ALL that apply) A. To split a larger volume workqueue by last name such as one workqueue A-M and thesecond N-Z B. To perform an initial filter that saves on system processing perf | A, B, & C |
| "For an account to qualify for a workqueue, what is the relationship between routing rules and workqueue rules? A. AND B. OR C. CUSTOM" | A. AND. For an account to qualify, it must qualify for all routing rules and at least one workqueue rules. |
| "Which of the following are types of system action queues? Select ALL that apply. A. Bucket B. Account C. Guarantor D. Invoice E. Encounter" | A, B, C |
| True or False: System action queues are based on rules. | True. |
| "True or False? The order of the system action queues listed in Queue Priority does not matter as all system action queues are evaluated against each bucket/account/guarantor every time." | "False. One action may change the characteristics of an account which could cause it to qualify or not qualify for other actions based on the change." |
| True or False? Hospital accounts are evaluated by system action queues before liability buckets. | False. Buckets are evaluated before hospital accounts. |
| What are SmartLinks? | Standard abbreviations that will pull information from the master files into each letter. |
| True or False: Letters can only be sent at the guarantor level. | False. Letters can be sent at the guarantor or hospital account level. |
| True or False: Account activities can have default values configured for their actions. | True. |
| "True or False: You can lock an individual action within an activity to prevent the end user from changing the configuration." | True. |
| Which are possible reasons why you cannot perform a billing activity that you have created? ALL that apply. A Your security class is not an authorized security class B The activity is not plugged in to the HSD. C The activity does not make sense in the | A, B, C |
| Name one difference between an HOV and a regular admission. | HOVs are not assigned a room and bed; HOVs are scheduled while admissions are not. |
| Define Hospital Outpatient Department (HOD). | An HOD is a unit that offers outpatient services to both inpatients and outpatients |
| Define Hospital Outpatient Visit (HOV). | "An HOV is an encounter created in a Hospital Outpatient Department. You need both Cadence and ADT to successfully create an HOV." |
| Why must you select a visit type when scheduling an appointment? | "The visit type determines the length of the appointment, the providers that are available for scheduling, and the time slots that will be available from each providers' schedule." |
| True or False: Reimbursement contracts affect the price of a charge. | FALSE |
| "True or False: The system allows you to create multiple reimbursement contracts with the exact same configuration on the Applies to Tab" | FALSE |
| "Which property from the Credit Record context property tree will allow you to identify a specific payment procedure code?" | Credit Record.ETR.Procedure |
| "True or False: Credit records are routed to Credit Workqueues overnight, when batch job 1185 is run." | False. Credit Records are routed to workqueues in real time. |
| When are follow-up records created? | When a claim run is accepted. |
| "Automatic activities can be set up in the follow-up workqueue or profile, but what must be built to allow the activities to actually be performed?" | Batch job 1184 - Follow-up Workqueue Automatic Activities must run. |
| True or False: Activities in the workqueues can be performed automatically or manually. | TRUE |
| "How do records qualify for a credit workqueue? How do they qualify for a follow-up workqueue?" | "Credits qualify for workqueues based on the rules listed in the Workqueue Routing section of the Credit Workqueue Profile. This is the same concept used to route follow-up records to Follow-up workqueues." |
| What, if any, batch jobs are used in credit/follow-up workqueues? | "Batch Job 1185 - Credit WQ Automatic Activities and Batch Job 1184 - Fol WQ Automatic Activities" |
| "Name two sections in the Credit Workqueue Profile and Follow-up Workqueue Profile where rules can be entered." | Workqueue Routing section and Automatic Activity Mapping section |
| "True or False: Records in the credit workqueue are considered temporary accounts receivable (TAR)." | False, the credit records represent payments that are posted to guarantor accounts. |
| True or False: Retroadjudication may cause a price change for the newly posted charge. | TRUE |
| True or False: Filing order changes can trigger visit filing order review | True - if the primary coverage for a charge changes. |
Created by:
jwharris77