HAC Electronic Health Records & Financial Systems 3 — Questions and Answers
Question 1: Which component of an EHR system directly feeds the Charge Description Master (CDM) to generate patient bills?
- Order entry and charge capture (Correct answer)
- Patient portal
- Population health module
- Care coordination dashboard
Correct answer: Order entry and charge capture
Order entry triggers charge capture events that pull billable items from the CDM to construct the patient bill.
Question 2: A healthcare accountant reviews an 835 transaction. What information does this EDI file contain?
- Patient eligibility response
- Electronic remittance advice from a payer (Correct answer)
- Pre-authorization request
- Claim status inquiry
Correct answer: Electronic remittance advice from a payer
The ASC X12 835 is the HIPAA-standard electronic remittance advice (ERA) file that details payer payment and adjustments.
Question 3: Which federal law mandated the adoption of certified EHR technology and introduced Meaningful Use incentive payments?
- HIPAA 1996
- HITECH Act 2009 (Correct answer)
- ACA 2010
- MACRA 2015
Correct answer: HITECH Act 2009
The HITECH Act established the EHR Incentive Programs (Meaningful Use) and tied financial incentives and penalties to certified EHR adoption.
Question 4: In value-based care contracts, which EHR data element is most critical for calculating shared savings for an ACO?
- Patient portal login frequency
- Attributed beneficiary cost and utilization data (Correct answer)
- Nurse staffing ratios
- Facility depreciation schedules
Correct answer: Attributed beneficiary cost and utilization data
ACO shared savings calculations depend on total cost of care and utilization patterns for attributed beneficiaries pulled from EHR and claims data.
Question 5: A claims scrubber rejects a claim before submission. What is the most likely reason?
- Patient signed an ABN
- Diagnosis code is missing or invalid for the billed procedure (Correct answer)
- Provider credentials are expired in the payer database
- Patient has a secondary insurance
Correct answer: Diagnosis code is missing or invalid for the billed procedure
Claims scrubbers check for coding edits such as missing or mismatched diagnosis codes relative to the billed CPT procedure.
Question 6: Which standard coding system is used to report physician and outpatient services on a CMS-1500 claim form?
- ICD-10-PCS
- CPT/HCPCS (Correct answer)
- MS-DRG
- ICD-10-CM only
Correct answer: CPT/HCPCS
CPT (Current Procedural Terminology) and HCPCS Level II codes describe procedures and services billed on CMS-1500 professional claims.
Question 7: What is the function of a 'lockbox' in the context of healthcare accounts receivable?
- Securing PHI in the EHR
- A bank service that captures and deposits patient payments and transmits remittance data (Correct answer)
- Encrypting EDI claim files
- Holding denied claims for appeal
Correct answer: A bank service that captures and deposits patient payments and transmits remittance data
A lockbox is a bank-operated service that receives, processes, and deposits payments, then sends remittance data electronically to the provider's AR system.
HAC Electronic Health Records & Financial Systems 3
Which component of an EHR system directly feeds the Charge Description Master (CDM) to generate patient bills?