Revenue Cycle and Billing Flashcards
7 cards from real Epic Skills Assessment practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Revenue Cycle and Billing flashcards as text
In Epic, the 'Collections' workqueue typically contains accounts that:
Answer: Have outstanding patient balances after payer adjudication
Collections workqueues surface patient-responsible balances that remain after insurance payments and adjustments have been posted.
A 'timely filing' denial occurs when:
Answer: The claim was submitted after the payer's deadline for submission
Payers enforce timely filing limits; claims submitted after the deadline are denied regardless of clinical validity.
Which Epic module is specifically designed to manage professional billing (physician billing) as opposed to hospital billing?
Answer: Resolute Professional Billing
Resolute Professional Billing in Epic handles charge entry, claim submission, and payment posting for physician and outpatient professional services.
In Epic, what does the 'Coordination of Benefits (COB)' process determine?
Answer: The order in which multiple payers are responsible for a patient's charges
COB establishes which payer pays first (primary), second (secondary), etc., preventing duplicate payment for the same service.
When a payer sends an 835 transaction file to Epic, it contains:
Answer: Electronic remittance advice with payment and claim adjudication details
The 835 is the HIPAA standard for Electronic Remittance Advice (ERA), detailing payer payments, adjustments, and denial reasons.
In Epic's Resolute module, a 'small balance write-off' is typically triggered when:
Answer: The remaining patient balance falls below a defined threshold amount
Small balance write-offs automatically close accounts where the remaining balance is too small to justify the cost of collection efforts.
Which action should a biller take in Epic when a claim is denied with reason code PR-1 (deductible amount)?
Answer: Bill the patient for the deductible amount the payer applied
PR-1 indicates the patient's deductible was applied; the patient-responsible portion should be billed to the patient, not resubmitted.