Exam (elaborations)
HB330 Resolute Hospital Billing Claims Exam
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HB330 Resolute Hospital Billing Claims Exam
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HB330 Resolute Hospital Billing ClaimsExam
Demand Claim - Answer -Allows you to print a paper claim right now and override the claim form,
account class, the Type of Bill and include only selected claim lines.
Resubmit Claim - Answer -Puts the insurance bucket back on the claims queue (even if the insurance
bucket is already outstanding).
Cancel Claim - Answer -Created when the initial claim was sent with incorrect information. Cancel claims
can be created even if the bucket has already been rejected. This allows billers to go back and send the
cancel claim if they have previously forgotten.
Claims Reconciliation - Answer -Creates a record for each claim in a claim run. Import claim status files
from clearinghouses (or payer) giving you a record of a claim's status once it has left Epic. Automation
based on communication.
ANSI 277 - Answer -Specifically formatted delimited file.
Delimited Flat File - Answer -Flat file that contains delimiters that indicate when the information in the
file changes from one piece of data to another.
Claim Medium - Answer -Setting in the CDF that specifies whether the claim form is paper or electronic.
CDF - Answer -Checks for payer or plan specific errors. Claim formatting and Claim error checking.
, Plan - Answer -Set of benefits a payer offers.
Payer - Answer -Insurance provider.
HSD - Answer -System settings for hospital billing.
HSD 1 - Answer -Facility Level Hospital Billing Profile - Settings made in here affect the entire facility
unless overridden by service area, location or user-level HSDs.
Recurring Billing Cycle - Answer -Define when a new HAR gets created for a series of appointments.
Charge Redirection Method - Answer -Determines which HAR in a recurring series a charge will post to.
Admit Date for IP Claims - Answer -Table that defines which date is used as the admit date on the claim.
Rule of Specificity - Answer -System will use the most specific setting available. If a setting is not found a
t the most specific level, it will continue looking up until a setting is found.
Alternate Payer - Answer -Allow the system to track simultaneous responsibility for a hospital account.
Two payers can both be primary payers for different services.
Medigap - Answer -Define a plan as this to suppress any charges that have already been submitted to
Medicare.
Crossover Payer - Answer -Payer is considered this when Medicare or another primary payer
automatically forwards a claim to the secondary payer.
Claim Attachment - Answer -Additional documentation that needs to be sent with the claim such as lab
test results, emergency room notes, or implant invoices.
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