Resolute Professional Billing Expected Reimbursement Contracts
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| show | Expected Reimbursement Amount
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| A charge post with a price of $77.00. This is the _________. | show 🗑
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| show | Allowed Amount
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| The difference between the price of the charge and what the payer agrees that you should be able to collect is $13.00. This is the ________________. | show 🗑
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| show | True
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| Professional Billing underpayments are worked from which type of workqueues: | show 🗑
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| 60432‐ Mult Px ‐ No Automation ‐ Reimbursement Contract: | show 🗑
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| show | Percent of Fee Schedule
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| show | Extension
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| show | False
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| show | TST
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| (T/F) Reimbursement Contracts affect the billing amount/price. | show 🗑
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| show | Not allowed amount
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| The PRICE of a charge sent out on the claim to the payer. | show 🗑
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| The amount built in your reimbursement contract that you EXPECT to collect. | show 🗑
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| show | Allowed Amount
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| The DIFFERENCE between the allowed amount and the billed amount that is WRITTEN OFF | show 🗑
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| (T/F) When a contracted payer pays a claim, the allowed amount from the reimbursement contract automatically populates the Allowed field for manual payment posting. | show 🗑
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| Test build before sending to PRD. | show 🗑
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| Live environment | show 🗑
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| Troubleshooting. Produced as a nightly copy of PRD. Also used to test build on real patient data befor it's migrated to PRD. | show 🗑
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| show | PJX, or Projects
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| In order for a contractual adjustment to occur, a charge needs to have both ___ and ____ | show 🗑
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| In which environment do end users perform their daily workflows? Choose ONLY one: | show 🗑
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| (T/F) All initial build is typically completed in the TST environment. | show 🗑
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| What records created from Registration are needed to test Reimbursement contract build? | show 🗑
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| show | Reimbursement Underpayment Detail Report
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| From which type of workqueue are underpayments worked? | show 🗑
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| show | Taking changes to the contract or pricing data and comparing it against historical claims data
already in the system.
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| (T/F) You can only model contract changes against claims from the past year. | show 🗑
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| (T/F) Making a copy of a contract for modeling will make a copy of the contract record as well as a copy of all records inside that contract (like components and fee schedule). | show 🗑
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| (T/F) To import records into Epic you can start with a blank spreadsheet as the column and row configuration does not matter | show 🗑
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| What is the import spec used to import Fee Schedules in Chronicles? | show 🗑
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| show | False
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| Which of the following are examples of rules that can be used in the MPPR table? | show 🗑
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| (T/F) Configuration in your reimbursement contract can re‐order charges on a claim set to CMS standards. | show 🗑
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| When using the Submit for Re‐eval option in Contract Maintenance, when do any selected actions occur? | show 🗑
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| (T/F) On the Service Components tab of a reimbursement contract, more specific contract lines should be listed higher in priority than more general contract lines. | show 🗑
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| show | Percent of BIlled
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| show | Service Components
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| show | Reimbursement Contract Precedence
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| show | General Settings
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| show | Applies To tab and characteristics of the specific charge session
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| The price of a charge sent out on the claim to the payer. | show 🗑
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| The amount built in your reimbursement contract that youexpect to collect. | show 🗑
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| In order to report on underpayments for the past year, which report world you use? | show 🗑
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| From which type of workqueue are underpayments worked? | show 🗑
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| Estimates are available for both prospective patients and existing patients looking for a future service | show 🗑
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| The amount built in your reimbursement contract that you expect to collect. | show 🗑
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| Actual collectable amount on the EOB from a payer. | show 🗑
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| The difference between the allowed amount and the billed amount that is written off. | show 🗑
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| Epic’s front‐end user interface, accessed on the client. It’s what most users think of as “Epic” and what you used in your Fundamentals class. End users log in to system to complete their workflows and do their jobs. | show 🗑
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| Estimates allow you to collect as much of the patient portion up‐front as possible In order for your estimates to be accurate, your organization needs accurate configuration in many areas,including pricing, benefits collection, real‐time‐eligibility, and | show 🗑
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| show | Classic
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| show | Chronicles
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| show | Annual calendar ‐ Simple
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| Text‐based, back‐end interface with Chronicles data, used solely by administrators for creating, editing, and analyzing records. Text runs directly on the server that hosts Chronicles, and you connect to it via a terminal emulator | show 🗑
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| show | Key Players
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| the adjustment posted during claims processing offsets the difference between the reimbursement amount calculated at charge entry and the reimbursement amount calculated during claims processing | show 🗑
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| show | Annual Calendar ‐ Detailed
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| Tab uses groups to identify procedures included in the reimbursement contract. Those procedures are associated with a payment mechanism which is configured to calculate the allowed amount. | show 🗑
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| The system will write‐off the difference only when the insurance payment is posted. | show 🗑
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| Your organization can determine if the billing or service provider is referenced when using a reimbursement contract with a Provider eligibility requirement | show 🗑
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| Values on the ____________tab reference Contract Grading and Builder Grading scales, both of which are found on the next tab in the spreadsheet. | show 🗑
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| On which tab of the reimbursement contract do you specify payment mechanisms for calculating expected reimbursement | show 🗑
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| A planning tool available on Galaxy. You'll gather information about your existing contracts, and the tool will help you prioritize the build required and timelines based on your available resources. | show 🗑
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| On which tab of the reimbursement contract do you configure when the write‐off is posted | show 🗑
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| show | False
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| show | Reimbursement Contract Precedence
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| show | Percent of Billed
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| True or False: On the Service Components tab of a reimbursement contract, more specific contract lines should be listed higher in priority than more general contract lines | show 🗑
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| show | Further Reductions
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| If a claim qualifies for your multiple procedures logic, the system automatically adds or removes the modifier and adjusts expected reimbursement according to the logic. | show 🗑
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| show | 60431‐ Mult Px ‐ Use Rule, Suppress Modifier
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| True or False: A charge session can ONLY qualify for one line of the Percentage Adjustments table. | show 🗑
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| show | This mode updates allowed amounts and allows for corrective write‐offs of the net
difference to be posted
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| show | When a batch job using template 1404 runs
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| show | False
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| The system doesn't automatically apply modifiers or adjust expected reimbursement based on multiple procedure logic, but expected reimbursement is adjusted if a user manually enters a modifier | show 🗑
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| the method the system uses to sort charges on a claim | show 🗑
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| This table generally allows you to follow Medicare's guidelines when it comes to payment of select services. | show 🗑
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| CMS rules are applied in ranking grouped charges by endoscopic family. The highest‐ranked charge within an endoscopic family is assigned an expected reimbursement equal to 100% of the allowed amount calculated by the lines of the contract. | show 🗑
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| show | Diagnostic Imaging Rule
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| This rule works very similarly to that of the Cardiovascular rule discussed earlier in the lesson except the MPI of the procedure is set to 7 and the TC is reimbursed at 80%. | show 🗑
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| show | Therapy Rule
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| Reporting Workbench Report run by a user in real‐time out of Hyperspace. | show 🗑
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| show | Reimbursement Underpayment Detail Report
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| show | Taking changes to the contract or pricing data and comparing it against historical claims data
already in the system
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| show | False
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| show | POC or Proof of Concept
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| a tool that allows you to move information between environments and maintain referential integrity between multiple environments. | show 🗑
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| show | PB Transaction Inquiry
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| Allow you to provide an up‐front look at the patient‐portion that will be owed by a patient for services you provide | show 🗑
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| show | Batch Scheduler
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| The system groups together charges listed in the claims queue with the same encounter information and runs them through the CDF. Clean claims stay in the run and submitted. | show 🗑
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| When a charge qualifies for multiple reimbursement contracts, which setting helps determine which contract is considered highest priority | show 🗑
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| show | True
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| show | False
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| True or false: To import records into Epic you can start with a blank spreadsheet as the column and row configuration does not matter. | show 🗑
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| When using the Submit for Re-eval option in Contract Maintenance, when do any selected actions occur. | show 🗑
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| show | reimbursement contract precedence
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| show | General Settings
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| show | flat rate
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| show | Service Components
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| show | Percent of Billed
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| True or False: On the Service Components tab of a reimbursement contract, more specific contract lines should be listed higher in priority than more general contract lines. | show 🗑
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Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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