Epic Skills Assessment Revenue Cycle and Billing 5 — Questions and Answers
Question 1: In Epic, the 'Collections' workqueue typically contains accounts that:
- Have been fully paid by the payer
- Have outstanding patient balances after payer adjudication (Correct answer)
- Are pending prior authorization approval
- Have charges in edit status
Correct answer: Have outstanding patient balances after payer adjudication
Collections workqueues surface patient-responsible balances that remain after insurance payments and adjustments have been posted.
Question 2: A 'timely filing' denial occurs when:
- The claim contains an invalid diagnosis code
- The claim was submitted after the payer's deadline for submission (Correct answer)
- The patient's policy was terminated at the time of service
- The claim was sent to the wrong clearinghouse
Correct 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.
Question 3: Which Epic module is specifically designed to manage professional billing (physician billing) as opposed to hospital billing?
- Cadence
- Resolute Professional Billing (Correct answer)
- Grand Central
- Willow
Correct answer: Resolute Professional Billing
Resolute Professional Billing in Epic handles charge entry, claim submission, and payment posting for physician and outpatient professional services.
Question 4: In Epic, what does the 'Coordination of Benefits (COB)' process determine?
- Which CPT codes are valid for a given diagnosis
- The order in which multiple payers are responsible for a patient's charges (Correct answer)
- Whether a patient qualifies for financial assistance
- How charges are split between departments
Correct 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.
Question 5: When a payer sends an 835 transaction file to Epic, it contains:
- New patient registration data
- Electronic remittance advice with payment and claim adjudication details (Correct answer)
- Prior authorization approvals
- Updated fee schedule rates
Correct 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.
Question 6: In Epic's Resolute module, a 'small balance write-off' is typically triggered when:
- A patient requests financial assistance
- The remaining patient balance falls below a defined threshold amount (Correct answer)
- A claim has been in accounts receivable over 365 days
- The payer issues a final denial
Correct 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.
Question 7: Which action should a biller take in Epic when a claim is denied with reason code PR-1 (deductible amount)?
- Resubmit the claim to the same payer with a corrected diagnosis
- Bill the patient for the deductible amount the payer applied (Correct answer)
- Submit the claim to a secondary payer immediately
- Write off the denied amount as a contractual adjustment
Correct 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.
Epic Skills Assessment Revenue Cycle and Billing 5
In Epic, the 'Collections' workqueue typically contains accounts that: