Electronic Health Records & Financial Systems Flashcards

A hospital switches EHR vendors. Which financial data migration risk poses the greatest threat to revenue continuity?

Answer: Incomplete migration of open AR balances and payer contract rates

Open AR balances and payer contract rates must migrate accurately; errors result in lost revenue, incorrect adjudication, and billing delays.

What is the purpose of a 'patient financial counselor' workflow integrated into an EHR system?

Answer: Providing cost estimates and payment plan options before or after service

EHR-integrated financial counseling tools generate price estimates and facilitate payment arrangements to improve upfront collection and reduce bad debt.

Under ICD-10-CM coding, what is the impact of 'clinical documentation improvement' (CDI) on a hospital's case mix index?

Answer: More specific documentation leads to higher-severity DRG assignments and a higher CMI

CDI queries physicians for specificity (e.g., 'sepsis' vs. 'septicemia') that drives higher-acuity DRG assignments, increasing the facility's CMI and reimbursement.

Which HIPAA transaction set is used by a provider to check a patient's insurance eligibility and benefit coverage in real time?

Answer: 270/271

The ASC X12 270 (eligibility inquiry) and 271 (eligibility response) transaction sets enable real-time verification of patient coverage and benefits.

A healthcare organization implements robotic process automation (RPA) in its EHR billing workflow. Which task is RPA best suited to automate?

Answer: Repetitive data entry tasks such as eligibility checks and claim status inquiries

RPA excels at high-volume, rule-based tasks like eligibility verification and claim status checks that involve navigating payer portals or EDI transactions.

What is a 'charge explosion' in the context of hospital EHR billing?

Answer: Automatic generation of multiple related charges from a single clinical order

Charge explosion occurs when one order (e.g., a comprehensive metabolic panel) automatically generates charges for all component tests based on predefined CDM rules.

Which data element in an EHR patient account is used to calculate the 'contractual allowance' adjustment on a claim?

Answer: Payer-specific fee schedule or contracted rate versus billed charge

The contractual allowance equals the difference between the billed charge and the contracted rate negotiated with a specific payer.