Epic Skills Assessment Revenue Cycle and Billing 3 — Questions and Answers
Question 1: In Epic, 'Coverage Discovery' is primarily used to:
- Identify patient diagnoses automatically
- Search for unknown or unreported patient insurance coverage (Correct answer)
- Calculate patient copays at check-in
- Generate prior authorization requests
Correct answer: Search for unknown or unreported patient insurance coverage
Coverage Discovery queries external databases to find active insurance plans a patient may not have reported.
Question 2: Which Epic report helps identify claims that have been submitted but not yet paid after a set number of days?
- Charge Lag Report
- Aging Report (A/R) (Correct answer)
- Remittance Summary
- Expected Reimbursement Report
Correct answer: Aging Report (A/R)
The Accounts Receivable (A/R) Aging Report categorizes outstanding claims by how long they have been unpaid.
Question 3: When a payer issues a 'denial' with remark code CO-97, this typically indicates:
- The claim was paid in full
- The benefit for this service is included in the payment of another service (Correct answer)
- The patient's deductible has not been met
- The claim was submitted to the wrong payer
Correct answer: The benefit for this service is included in the payment of another service
CO-97 means the payment for the denied service is considered bundled into another service already reimbursed.
Question 4: In Epic's charge capture workflow, what does 'charge lag' measure?
- The time between a claim denial and resubmission
- The delay between service delivery and charge entry (Correct answer)
- The gap between payment posting and patient statement generation
- The time a claim spends in the billing hold queue
Correct answer: The delay between service delivery and charge entry
Charge lag is the number of days between when a service is provided and when the charge is entered into Epic.
Question 5: Which Epic feature allows patients to pay balances online and view itemized bills through a self-service portal?
- Referral Management
- MyChart Billing (Correct answer)
- Grand Central
- Charge Router
Correct answer: MyChart Billing
MyChart Billing enables patients to view statements, make payments, and set up payment plans online without calling the billing office.
Question 6: A 'crossover claim' in Epic's billing context refers to:
- A claim sent to both a commercial and government payer simultaneously
- A claim automatically forwarded from Medicare to Medicaid for secondary billing (Correct answer)
- A claim submitted across state lines
- A claim that crosses fiscal year boundaries
Correct answer: A claim automatically forwarded from Medicare to Medicaid for secondary billing
Crossover claims are automatically transferred from Medicare to Medicaid (or other secondary payers) by the payer after primary adjudication.
Question 7: In Epic, the 'Expected Reimbursement' amount on a charge is calculated based on:
- The chargemaster list price
- The contracted fee schedule negotiated with the payer (Correct answer)
- The national average cost for the procedure
- The patient's historical payment patterns
Correct answer: The contracted fee schedule negotiated with the payer
Expected reimbursement reflects the contracted rate from the payer's fee schedule loaded into Epic, not the full chargemaster price.
Epic Skills Assessment Revenue Cycle and Billing 3
In Epic, 'Coverage Discovery' is primarily used to: