Epic Skills Assessment Revenue Cycle and Billing 4 — Questions and Answers
Question 1: Which Epic tool is used to manage and track prior authorization requests submitted to payers?
- Order Composer
- Authorization Tracking (Correct answer)
- Claim Edit
- Coverage Discovery
Correct answer: Authorization Tracking
Authorization Tracking in Epic allows staff to record, monitor, and manage prior authorization statuses for procedures and services.
Question 2: In Epic revenue cycle, what is the function of the 'Guarantor' record?
- It stores clinical notes for billing purposes
- It identifies the person financially responsible for the account (Correct answer)
- It tracks payer contracts and fee schedules
- It logs charge corrections made by billing staff
Correct answer: It identifies the person financially responsible for the account
The Guarantor in Epic is the individual legally responsible for payment on the account, which may differ from the patient.
Question 3: When Epic generates an 837P file, this is used for:
- Inpatient institutional claim submission
- Professional claim submission to payers electronically (Correct answer)
- Patient demographic verification
- Pharmacy benefit management
Correct answer: Professional claim submission to payers electronically
The 837P is the HIPAA-standard electronic transaction format for professional (physician) claims submitted to payers.
Question 4: A charge posted in Epic with the wrong CPT code should be corrected by:
- Deleting the charge and re-entering a new one
- Using the charge correction function to modify the existing charge (Correct answer)
- Voiding the claim and submitting a paper claim
- Contacting the payer directly to update the code
Correct answer: Using the charge correction function to modify the existing charge
Epic's charge correction function allows authorized staff to modify charge details, maintaining an audit trail of the change.
Question 5: Which of the following best describes 'write-off' in Epic's revenue cycle?
- Transferring a balance to another payer
- Reducing an account balance by an amount that will not be collected (Correct answer)
- Posting a payment from the patient
- Placing an account in a payment plan
Correct answer: Reducing an account balance by an amount that will not be collected
A write-off removes an uncollectable balance from the accounts receivable, recognizing it will not be recovered.
Question 6: In Epic, 'real-time eligibility verification' (RTE) helps prevent claim denials by:
- Submitting claims faster than standard batch processing
- Confirming active insurance coverage before or at the time of service (Correct answer)
- Automatically correcting diagnosis codes on claims
- Generating patient cost estimates at scheduling
Correct answer: Confirming active insurance coverage before or at the time of service
RTE queries the payer's database in real time to verify that a patient's insurance is active and coverage details are correct.
Question 7: Which Epic functionality automatically routes charges to the appropriate billing provider based on predefined rules?
- Grand Central
- Charge Router (Correct answer)
- Resolute
- Referral Management
Correct answer: Charge Router
Charge Router applies rules to direct charges to the correct billing provider, payer, or account type without manual intervention.
Epic Skills Assessment Revenue Cycle and Billing 4
Which Epic tool is used to manage and track prior authorization requests submitted to payers?