Electronic Health Records & Financial Systems Flashcards

A hospital's EHR generates a UB-04 claim. Which patient type is this form used for?

Answer: Inpatient and outpatient institutional (hospital) claims

The UB-04 (CMS-1450) is the standardized claim form used by hospitals and other institutional providers for inpatient and outpatient billing.

Which EHR security control best protects the integrity of financial transaction data from unauthorized modification?

Answer: Audit logging with tamper-evident trails

Tamper-evident audit logs record every modification to financial records, providing an immutable trail that detects unauthorized changes.

Under the CMS Cost Report (Form 2552-10), what does the cost-to-charge ratio (CCR) help determine?

Answer: The proportion of charges that represent actual costs for Medicare reimbursement calculations

The CCR converts a hospital's billed charges to estimated costs, which CMS uses to calculate cost-based reimbursement and outlier payments.

A revenue integrity auditor finds duplicate charges on a patient account. Which EHR workflow most commonly causes this issue?

Answer: Interface engine re-sending messages due to acknowledgment failures

When interface engines re-transmit HL7 ADT or order messages after a failed ACK, duplicate charge events can be created in the billing system.

Which federal program requires eligible clinicians to report quality measures through the EHR to avoid a Medicare payment penalty?

Answer: MIPS (Merit-based Incentive Payment System)

MIPS under MACRA requires eligible clinicians to report quality, cost, and improvement measures; failure results in a negative payment adjustment.

In EHR financial reporting, what does 'net days revenue outstanding' (NDRO) measure differently from gross days in AR?

Answer: NDRO uses net AR after contractual adjustments while gross days in AR uses total billed charges

NDRO divides net accounts receivable (after contractual allowances) by average daily net patient revenue, providing a more accurate picture than gross AR metrics.

Which type of EHR report helps a healthcare CFO identify payer mix trends that affect revenue forecasting?

Answer: Accounts receivable aging report by payer category

An AR aging report stratified by payer shows how much revenue is owed by Medicare, Medicaid, commercial, and self-pay segments, informing cash flow forecasts.