CLR301: CLARITY DATA MODEL - RESOLUTE HB EXAMS WITH ACTUAL CORRECT QUESTIONS AND VERIFIE, Exams of Nursing

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CLR301: CLARITY DATA MODEL - RESOLUTE

HB EXAMS WITH ACTUAL CORRECT

QUESTIONS AND VERIFIED DETAILED

RATIONALES ANSWERS 2024(NEWEST)

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Recurring Accounts These special types of hospital accounts allow related outpatient visits, such as physical therapy sessions, to be billed together on the same claim. Charges from each encounter in the series will be sent to the same hospital account which can be set to bill after a certain amount of time. Institutional Accounts These accounts are attached to an institutional guarantor account and serve a specific purpose for billing multiple patients to the same company. For instance, a company might have one of these accounts for its employee drug screenings or flu shots. Combined Accounts There are cases where it is necessary to combine two previous hospital accounts into one. The most prominent example is compliance with the Medicare "three-day rule". Medicare requires related outpatient visit within three days of an inpatient stay be billed on the Inpatient claim. False - Do not use the billing status of "Combined" to identify source accounts as this status will eventually be changed to "Closed." Instead, look for accounts where COMBINE_ACCT_ID is not null. True or False: You should use the billing status of "Combined" to identify source Combined Accounts? True - HSP-ACCOUNT is a no-add single response table making reporting difficult. HSP_HAR_SNAPSHOT table contains detailed information about hospital accounts as of midnight for a given date and allows for more robust reporting. True or False: For Historical Hospital Account Snapshot you should use the HSP_HAR_SNAPSHOT table instead of the HSP_ACCOUNT Table. No. Account class can be expanded per your needs, but only three account base classes exist - Inpatient, Outpatient, and Emergency. Do "account class" and "account base class" refer to the same list of categories? No. TOT_ACCT_BAL will equal zero, but TOT_CHGS will still contain the total amount of charges that were ever placed on the account. For a paid-off hospital account, will HSP_ACCOUNT.TOT_CHGS equal zero?

Yes. It reflects the coded time of discharge, which can potentially differ from the clinically documented time of discharge. Can HSP_ACCOUNT.DISCH_DATE_TIME be different from the date and time of discharge found in the patient's chart? No - Only if your organization is using account-level bad debt. Will all delinquent hospital accounts have HSP_ACCOUNT_3.BAD_DEBT_FLAG_YN set to Y? A facility-defined category list that can be used to mark hospital accounts. What is a billing indicator? True True or False: The first time anyone enters the Coding Info activity for a given hospital account, they are asked if they want to start coding the account. Saying "yes" to this prompt causes the user's ID to be stored in the account and starts a clock which can be used to track the performance of individual coders. True True or False: Much of the information here defaults in from the patient's clinical and ADT documentation (such as their admission date and time, their admitting and attending providers, and their primary service), but any of it can be changed on the hospital account for billing purposes. False - Note that information on this form will not flow backward to the patient's clinical documentation

• if an admission's primary service is changed here, for example, the hospital account and patient records may list different primary services for the stay. True or False: Information on the Coding ADT Info tab can flow backward to the patient's clinical documentation - if an admission's primary service is changed here, for example, the primary service for the hospital account will change also. True True or False: If you need information from a patient's chart (i.e. clinical information) instead of coding information, use PAT_ENC_HSP and its associated tables from the Inpatient and ADT data models. True True or False: In Clarity, diagnoses are stored in the CLARITY_EDG table and can contain ICD-9 or ICD codes? Admission Diagnosis The HSP_ACCT_ADMIT_DX table in Clarity stores what type of diagnosis codes? Final Diagnosis

The HSP_ACCT_DX_LIST table in Clarity stores what type of diagnosis codes? External Injury Codes The HSP_ACCT_EXTINJ_CD table in Clarity stores what type of diagnosis codes? Procedure Codes The CL_ICD_PX table in Clarity stores what type of codes? True True or False: The Procedures tab allows coders to add ICD and/or CPT procedure codes to a hospital account. ICD-coded procedures The HSP_ACCT_PX_LIST table in Clarity stores what type of codes? CPT and HCPCS-coded procedures The HSP_ACCT_CPT_CODES table in Clarity stores what 2 types of codes? ONE Each hospital account has exactly ______ guarantor, but can have multiple insurance coverages PATIENT Current patient Demographics stored in what table? PAT_ENC_HSP Hospital Encounter information is stored in what table? False - Except for institutional accounts True or False: You can only have one patient per hospital account. False - Except for recurring accounts True or False: You can only have one encounter per hospital account. True True or False: PATIENT.PAT_ID is a unique Epic identifier that is not recognizable to end users. True True or False: PATIENT.PAT_MRN_ID is an identifier that is recognizable to end users but may not be unique PATIENT In what table would you find patient demographics as of the last Clarity extract?

HSP_ACCOUNT

In what table would you find patient demographics as they were at the moment the patient was discharged? Hospital Encounter A single patient visit to the hospital is called a ____ _____. PAT_ENC_HSP - Some major outpatient encounters, like HOVs, may be included, but office visits, telephone calls, and so on are not. In what table are hospital encounters stored? PAT_ENC In what table are ALL patient encounters stored PAT_ENC stores all encounters, while PAT_ENC_HSP only stores hospital encounters. What is the main difference between the PAT_ENC_HSP and PAT_ENC tables? One - Each row in PAT_ENC_HSP will be connected to one row in HSP_ACCOUNT Each hospital encounter must be linked to exactly _______ hospital account. True - This arises when several encounters should be billed together for example, a series of physical therapy appointments True or False: A hospital account can be linked to multiple encounters. True - These columns may conflict as the result of coding the hospital account to meet insurer standards True or False: Similar columns exist in PAT_ENC_HSP and HSP_ACCOUNT PAT_ENC_HSP What table is the source of clinically accurate information? ACCOUNT.ACCOUNT_TYPE_C Type of guarantor can be found in what field? HB_ Hospital Billing Balance Columns start with what? TOTAL_BALANCE Professional Billing Balance Columns have generic-sounding names like? Current The ACCOUNT table has _____ Guarantor Demographics The patient was discharged

The HSP_ACCOUNT table has Guarantor demographics as they were when _____ _______ _____ ___________. PAYOR An insurance company (Benefit) Plan A specific package of benefits offered by a payor. Subscriber The individual in whose name the insurance was issued Coverage Combination of payor, plan, and subscriber Billing Status Where is this hospital account in the revenue cycle? Account Class - User Defined What kind of admission is this hospital account attached to? True True or False: Each account class maps to one of three account base classes: inpatient, outpatient, or emergency. CLARITY_EPM.Financial_Class The category value in CLARITY_EPM is associated with the payor's financial class. It links to ZC_FIN_CLASS? True True or False: All hospital accounts have a service area True True or False: All hospital accounts may also have a location, but this is optional True True or False: Coding can cause the admission and discharge times in HSP_ACCOUNT to differ from those in PAT_ENC_HSP PRIM_ENC_CSN_ID, but to report on all encounters, link from PAT_ENC_HSP using the HSP_ACCOUNT_ID column instead What table should you use to link a hospital account to its primary encounter?

HSP_ACCOUNT.ACCT_BILLED_DATE

What field shows the Last time the hospital account was billed? HSP_ACCOUNT.ACCT_ZERO_BAL_DT What field shows the Most recent date the account had a zero balance? HSP_ACCOUNT.ACCT_CLOSE_DATE What field Usually 14 days after the balance reaches zero HSP_ACCOUNT.CLAIM_ID Name the field where the CLM record is an internal Epic structure, and is generally not useful for reporting. This is not an insurance claim. Generally, do not use. Bucket-Level Bad Debt Delinquent balance moved from Self-Pay bucket to Bad Debt liability bucket Bucket-Level Bad Debt Billing status of the hospital account is set to "Bad Debt" Bucket-Level Bad Debt HSP_ACCOUNT.ACCT_BILLSTS_C = 20 Account-Level Bad Debt Delinquent balance remains in the Self-Pay bucket Account-Level Bad Debt "Bad Debt Flag" set on the hospital account Account-Level Bad Debt HSP_ACCOUNT_3.BAD_DEBT_FLAG_YN = "Y" True True or False: Self-pay levels determine the messages guarantors receive on statements True True or False: Reporting on a hospital account's self-pay level can reveal trends in how guarantors respond to collection attempts HSP_ACCT_SPLVL_HX What is the main table for reporting on Self-Pay history? HSP_ACCT_SPLVL_HX.CHANGE_INST_DTTM

What field do your use to report the date and time the instant the self-pay levels changed HSP_ACCT_SPLVL_HX.SP_LEVEL_C What field do your use to report on the new self-pay level: HSP_ACCT_SPLVL_HX.USER_ID In the HSP_ACCT_SPLVL_HX table, what field do your use to report on the User who made the change: HSP_ACCT_BILL_IND What is the main table for reporting on Billing Indicators? DNB can only be added by the system Who adds DNB Checks? Both users and the system can add Stop Bills Who add Stop Bills? HSP_ACCT_DNB_SB_HX What table do you use for Historical information about Stop Bills and DNB checks? HSP_ACCT_DNB_SB_HX.HX_DNB_SB_C

• 1 - DNB Check
• 2 - Stop Bill
• 3 - RAP Check (Used in Home Health)
• 4 - Billing Indicator What field do you use to distinguish Historical information about Stop Bills and DNB checks? HSP_HAR_SNAPSHOT What table stores detailed historical information about hospital accounts? HSP_HAR_SNAPSHOT.SNAP_START_DATE and HSP_HAR_SNAPSHOT.SNAP_END_DATE What columns in the HSP_BKT_SNAPSHOT define the date range when the data on a row was valid True True or False: Every day, at midnight, new rows are added to HSP_HAR_SNAPSHOT for any hospital accounts that have changed since the previous day HSP_ACCOUNT What table stores Coded Information about how payors determine what to pay? PAT_ENC_HSP, and many more What table stores Clinical Information about what actually happened during a visit

True True or False: The information stored in the fields in HSP_ACCOUNT can be edited for billing purposes and Changes do not "filter back" CLARITY_EDG Diagnosis reports use a lookup table called? CLARITY_EDG.DX_ID CLARITY_EDG Internal ID, unrecognizable to end users CLARITY_EDG.DX_NAME CLARITY_EDG Diagnosis name as seen in Hyperspace CLARITY_EDG.REF_BILL_CODE What field in CLARITY_EDG table gives the External ICD code? CLARITY_EDG.REF_BILL_CODE_SET_C CLARITY_EDG Category of the code set of this diagnosis code, for example ICD-9 or ICD-10. Links to ZC_EDG_CODE_SET. HSP_ACCT_ADMIT_DX The Admission Diagnoses are stored in what table? HSP_ACCT_DX_LIST The Final Diagnoses are stored in what table? HSP_ACCT_EXTINJ_CD The External Causes of Injury codes are stored in what table? CL_ICD_PX Reports on procedures use a lookup table similar to CLARITY_EDGcalled CL_ICD_PX.ICD_PX_ID What field in CL_ICD_PX stores Internal ID? CL_ICD_PX.PROCEDURE_NAME What field in CL_ICD_PX stores Procedure name in Hyperspace? CL_ICD_PX.REF_BILL_CODE What field in CL_ICD_PX stores External ICD code?

HSP_ACCT_PX_LIST

ICD Procedures are stored in what table? HSP_ACCT_CPT_CODES CPT/HCPCS-coded procedures on the hospital account are stored in what table? HSP_ACCT_EVENTS Procedure Events are stored in what table? True True or False: Procedure Events are used to store information about anesthesia, including the type, ASA class, and provider True True or False: An event that is not attached to at least one procedure is meaningless and will be placed in workqueue for follow-up CLARITY_DRG_MPI_ID.MPI_ID_TYPE or HSP_ACCOUNT.BILL_DRG_IDTYPE_ID these fields are linked together What field stores the Billing DRG version? CLARITY_DRG_MPI_ID.MPI_ID What field stores the Billing DRG code? HSP_ACCT_MULT_DRGS.DRG_MPI_CODE What field stores All DRGs? Three - HSP_ACCOUNT, HSP_ACCT_CDSTS_HX, and F_CODING_STATUS_DURATION How many tables provide coding status information for Auditing Coding Performance. HSP_ACCOUNT_2.CODING_TIME column stores how many seconds have elapsed since coding began. What Coding Performance field(s) are stored in HSP_ACCOUNT? Detailed audit trail of each step in the coding process What is stored in the HSP_ACCT_CDSTS_HX table? F_CODING_STATUS_DURATION.ELAPSED_TIME column stores the number of minutes the account stayed in a given status What Coding Performance field(s) are stored in F_CODING_STATUS_DURATION? Charges dropped to prebilled bucket

What is the first step of Liability Flow? Billing initiated, liability sent to insurance bucket What is the second step of Liability Flow? Insurance payments posted What is the third step of Liability Flow? Repeat for additional payors What is the fourth step of Liability Flow? Balance sent to self-pay bucket What is the fifth step of Liability Flow? Guarantor payments posted What is the sixth step of Liability Flow? Prebilled and Undistributed What are the two Prebilling Buckets? Prebilled Name the Bucket by it's Characteristics: •Charges collect here before being billed •One per hospital account Undistributed Name the Bucket by it's Characteristics: •Holds unexpected payments •Invisible to users until it is needed •One per hospital account Claim Name the Bucket by it's Characteristics: •One bucket per payor •Organized by filing order Interim Name the Bucket by it's Characteristics: •Used when the patient is still admitted, but billing should begin •Triggered by either length of stay or the balance on the hospital account Self-Pay

Name the Bucket by it's Characteristics: •Liability held by the guarantor •One per hospital account Bad Debt Name the Bucket by it's Characteristics: •Only appears if your organization is using bucket-level bad debt true True or False: The HSP_BKT_ACT_HX stores •Detailed audit trail of things that have happened to a liability bucket •One line for each bucket action performed by a user or the system •Can be used to determine when claims were printed or denials logged V_ARHB_BKT_AGING_DETAIL What table do you use to report on Bucket Aging? True

• Includes the names of several foreign key columns
• Performs aging calculations automatically
• Customized by setting properties on your database True or False: V_ARHB_BKT_AGING_DETAIL.HSP_BKT_AGING_HX tracks buckets with non-zero balances. True
• For example, EPIC SERVICE AREA [1]
• These columns can be displayed to report consumers but are also unique identifiers True or False: in the V_ARHB_BKT_AGING_DETAIL table, Columns that end with "NM_WID" contain both a name and ID. True
• For example, CALC_FIN_CLASS_NM_WID can separate residual self-pay from uninsured self-pay True or False: in the V_ARHB_BKT_AGING_DETAIL table, "CALC" columns contain additional logic to provide more detailed information. HSP_BKT_SNAPSHOT Name the table by it's Characteristics: •Stores detailed information about liability buckets as of midnight for a given date. •Same structure as HSP_HAR_SNAPSHOT •SNAP_START_DATE and SNAP_END_DATE columns indicate the range in which a given snapshot for a bucket is valid

F_ARHB_PAYOR_METRICS

The Payor Metrics report is

• Epic-released report that tracks payor performance
• Days to payment
• Underpayment rate
• Denial Rate And is powered by what table? True True or False: Charge Transactions are Posted manually by users or automatically by the system. False - Charges caught in a charge review workqueue are"temporary" transactions and don't appear in Clarity True or False: Charges caught in a charge review workqueue are "temporary" transactions and still appear in Clarity Payments __________ Can come with an Explanation of Benefits, or EOB Adjustments ___________ are "Other" transactions, like those that move balances between buckets and Divided into credits and debits True True or False: Transactions get their account class from the hospital account False - If the hospital account's class changes later, the system can reverse and repost True or False: If the hospital account's class changes later the account class stays the same False - You can manually determine base class using HSD_BASE_CLASS_MAP True or False: Account base class is stored on transactions True - The system can reverse and repost if the primary coverage changes True or False: Charges get their financial class from the primary coverage on the hospital account True True or False: Payments and adjustments get their financial class from the coverage on the bucket they were posted to Procedures ________ provide additional information about a transaction
• Only for charges do they correspond to a procedure in the clinical sense

HSP_TRANSACTIONS.PROCEDURE_DESC

________ is the best source of information

• This column will contain either the procedure's name or something better (e.g. medication data from Willow) HSP_TRANSACTIONS.DFLT_PROC_DESC ________ will contain the procedure's name if PROCEDURE_DESC was overridden Cost Centers __________: •Customizable list used to group charges •System can be set up to automatically assign a cost center to all charges
• Can be overridden by users •NOT part of the facility structure CL_UB_REV_CODE What table will contain the external UB Revenue Codes? True True or False: To get CPT/HCPCS Codes, use HSP_TRANSACTION.HCPCS_CODE unless it's blank, then use HSP_TRANSACTION .CPT_CODE False - End users working on these charges in a charge review workqueue or entering them manually also have access to many of these fields via the Additional Charge Info window. True or False: End users working on charges in a charge review workqueue or entering them manually do not have access to many of these fields via the Additional Charge Info window. CLARITY_MEDICATION What table does HSP_TRANSACTION.ERX_ID link to? RX_NDC What table does HSP_TRANSACTION.NDC_ID link to? OR_SPLY What table does HSP_TRANSACTION.SUP_ID link to? True True or False: Information about the patients associated with an institutional billing account is stored on the individual charge transactions

INST_BILL

• INST_BILL_PAT_NAME

• INST_BILL_SSN

• INST_BILL_COMMENT

• Etc. The relevant columns in Institutional Billing begin with ________ ________? V_ARHB_REVENUE_WITH_ADR When transaction-level detail isn't needed, this table's view will improve the performance of reports BUCKET_ID What table's Characteristics are: BUCKET_ID •All payments/adjustments are posted to a bucket •Can be used to link to HSP_BUCKET •NOT populated for charges PAYOR_ID What table's Characteristics are: •Only populated for payments/adjustments posted to insurance buckets •Can be used to link to CLARITY_EPM •NOT populated for charges System Adjustments ___________ ____________: •Used to move balances between buckets or to external AR/bad debt •Always come in pairs and always sum to zero •Unless they move money to or from external AR/bad debt
• IS_SYSTEM_ADJ_YN = "Y" Refunds __________:
• Considered debit adjustments since they decrease AR
• NOT payment reversals
• IS_REFUND_ADJ_YN = "Y"
• RFND_SND_TO_Cstores who received the refund (guarantor, patient, coverage, etc.)
• Depending on this value, other columns populate with more specific information Where F_ARHB_INACTIVE_TX.TX_ID is NULL What SQL code do you use to get Inactive Transactions?
• A transaction is considered "active" if it has not been

reversed and is not a reversal

• F_ARHB_INACTIVE_TXlists all inactive transactions along with the date they became inactive F_ARHB_HAR_TX_SUM Tracks the following
• Total amount per transaction type
• Net effect of all transactions
• Net effect on AR
• Bad debt activity ___________________ summarizes transactions posted in a given month by hospital account
• Only hospital accounts with transactions posted during the month will be included HSP_EXEC_SUMMARY __________________ can group transactions by
• Post Date • Service Area
• Location • Account Base Class
• Bucket Type • Financial Class
• Payor • Plan
• Product Type (HMO, PPO, etc.) HSP_EXEC_SUMMARY __________________ also stores
• Beginning balance
• Total amount per transaction type
• Total amount of transfers
• Ending balance F_ARHB_FM_METRICS Financial Management Reporting: __________________ simplifies the calculation of key performance indicators F_ARHB_FM_METRICS The __________________ table Tracks data by service area and location on a daily basis
• Stores
• Total, net, and average revenue
• Contractual, bad debt, and charity write-offs
• Net and billed AR
• AR aging categories V_AR_FYTD_ACTIVITY Combining HB and PB Transactions __________________ summarizes the count and amount of transactions posted within the current financial year

• Transactions are grouped by service area, location, and post date BILLING_APPLICATION In the V_AR_FYTD_ACTIVITY table, the __________________ column tracks whether the transactions come from HB or PB V_ARHB_BDC We track denials, remarks, and correspondences using BDC records. Each BDC record creates a row in what table? OPEN_DENIAL_BDC_YN This field in the HSP_ACCOUNT_2 and HSP_BUCKET tables tells you Are there open denials? OPEN_RMK_BDC_YN This field in the HSP_ACCOUNT_2 and HSP_BUCKET tables tells you Are there open remarks? OPEN_COR_BDC_YN This field in the HSP_ACCOUNT_2 and HSP_BUCKET tables tells you Are there open correspondences? V_ARHB_BDC Denial Amounts - Invoice-level The _________________ table,
• Payors might give a single response to the entire claim
• This view tracks billed, allowed, paid, and denied amounts HSP_BDC_DENIAL_DATA HSP_BDC_DENIAL_DATA also contains invoice-level information, but it is less efficient Denial Amounts - Line-level The __________________ table
• Payors might respond to each line of a claim
• Use the filter LINE_ON_EOB <> -1 to avoid including invoice-level information V_AR_CLAIMS_SUMMARY What table tells you How many claims did we send?
• Stores counts and amounts of accepted claims
• Broken down by service area, location, claim date, and billing application
• Separate columns for primary/secondary and initial/rebill V_AR_EDITS_SUMMARY What table tells you What prevents claims from being sent?
• Stores counts of DNB checks, Stop Bills, and claim edit checks
• Also tracks the amount of the associated accounts or claims

• Broken down by service area, location, account base class, owning area, edit type, and billing application
• Can exclude accounts still in min days
• Customizable edit checks HSP_BFH_ACTIVITY What table should you use for Tracking Account Activities: •One row per account activity •ACTIVITY_INST_DTTM stores the instant the activity was performed •FROM_WORKQUEUE_ID is populated if the activity was performed from a workqueue •USER_ID tracks the user who performed the action HSP_BFH_ACT_DATA What table for Tracking Account Activities: •One row per action •Remember a single activity can perform several actions •ACTION_C stores the kind of action •Send letter, add stop bill, etc. •ACTION_DATE holds the user-entered date for the action, not the date the action was performed HSP_BFH_HOSP_TXS For hospital billing, ________________ stores the amount each activity is credited with HSP_BFH_PROF_TXS what table for professional billing stores the amount each activity is credited with? Plan A package of insurance benefits provided by a single payor. Coverage The specific insurance plan owned by a subscriber, which can cover specific patients. Guarantor The most basic difference is that a guarantor is a party that can be responsible for charges, and a guarantor account is a guarantor acting in a certain capacity. Hospital Account A collection of financial information relating to a single patient encounter or episode of care. What is the difference between a hospital account and a guarantor account?

Each hospital account must be backed by one and only one guarantor account, while a guarantor account can back many hospital accounts. False True or False: The PATIENT address is current-state, while the HSP_ACCOUNT address is populated and frozen when the patient is registered. PATIENT_BALANCE and HB_SELFPAY_BALANCE If you want to report on the balance actually owed by a guarantor, you'll need to add what 2 columns together? HSP_ACCOUNT The patient demographics columns in ______________ are not populated until the patient is discharged. PATIENT If you are writing a report that might include hospital accounts for patients that are still in-house, you will need to link to the ______________ table to retrieve their demographic information. True - In an emergency case (such as an unidentified, unconscious patient who clearly can't be asked for insurance information), a generic hospital account will be created and filled in with a guarantor later. True or False: All admitted patients must have a hospital account - it's not possible to admit a patient in Epic without specifying where the admission's charges should be collected. HSP_ACCOUNT To report on all hospital encounters attached to a hospital account, use PAT_ENC_HSP.HSP_ACCOUNT_ID to link to ________________. Guarantor The __________ of a hospital account is the person or entity who is ultimately responsible for paying off whatever portion of the hospital account's balance is not paid for by insurance. False - All hospital accounts have exactly one guarantor True or False: A hospital account can have more than one guarantor. False - patient demographics stored in HSP_ACCOUNT, these columns are not populated until the patient is discharged. True or False: If I am writing a report that will include hospital accounts for patients that are still in- house, I can use HSP_ACCOUNT?

Coverage In Epic, a ____________ is defined as a single benefit plan, provided by a single payor, and owned by a single subscriber. CLARITY_EPM (insurance Payors) and/or CLARITY_EPP (Insurance Plans) What two tables do you use to report on Insurance COVERAGE_MEM_LIST What table links Coverage-to-Patient? ACCT_GUAR_PAT_INFO You can report on which guarantors are associated with which patients using the _________________ table. ACCT_COVERAGE To see all of the insurance coverages associated with a guarantor account, you can use the __________ table. As soon as (or before) a patient enters the facility When is a hospital account opened? An account stays open until every charge on the account has been paid, written off, or otherwise accounted for. When is a hospital account closed? DNB (Discharged Not Billed) What is a patient's hospital account's status upon discharge? Billing Status ________ ________ keeps track of where a hospital account is in its lifecycle. Account Class ________ ________ is a custom category list used to group hospital accounts by the type of visit they pertain to. Most facilities have account classes called Inpatient, Outpatient, and Emergency, but the list is customizable. Account Base Class ________ ________ ________ is an Epic-released list of only three values: Inpatient, Outpatient, and Emergency. Financial Class

________ ________ is a custom category list your facility can define to mark the difference between payors. Categories often include values like Commercial or Medicare. False -The financial class does not change as the balance on the hospital account is billed to secondary coverages or when any residual balance is billed to the guarantor. True or False: The financial class changes as the balance on the hospital account is billed to secondary coverages or when any residual balance is billed to the guarantor. Zero - the hospital account would have a balance of zero, but $10 in total charges and -$10 in total payments. If $10 is charged to a hospital account and then paid off by the guarantor, what would be the Balance of the hospital account? Bucket-Level Bad Debt and Account-Level Bad Debt What are the two ways Epic writes off accounts to Bad Debt? True True or False: Bad Debt is a status indicated by HSP_ACCOUNT.ACCT_BILLSTS_HA_C only when using bucket-level bad debt. Self-Pay ________-________ levels determine the messages guarantors receive on statements, and are an instrumental part of the self-pay portion of the revenue cycle. Billing Indicators You can define and use ________ ________ to indicate something special about the hospital account. Stop Bill A ________ ________ is placed on a hospital account either by the system or manually by an end user to prevent bills or claims from being processed Coverage The specific insurance plan owned by a subscriber, which can cover specific patients. Guarantor The most basic difference is that a guarantor is a party that can be responsible for charges, and a guarantor account is a guarantor acting in a certain capacity. Hospital Account A collection of financial information relating to a single patient encounter or episode of care.

What is the difference between a hospital account and a guarantor account? Each hospital account must be backed by one and only one guarantor account, while a guarantor account can back many hospital accounts. False True or False: The PATIENT address is current-state, while the HSP_ACCOUNT address is populated and frozen when the patient is registered. PATIENT_BALANCE and HB_SELFPAY_BALANCE If you want to report on the balance actually owed by a guarantor, you'll need to add what 2 columns together? HSP_ACCOUNT The patient demographics columns in ______________ are not populated until the patient is discharged. PATIENT If you are writing a report that might include hospital accounts for patients that are still in-house, you will need to link to the ______________ table to retrieve their demographic information. True - In an emergency case (such as an unidentified, unconscious patient who clearly can't be asked for insurance information), a generic hospital account will be created and filled in with a guarantor later. True or False: All admitted patients must have a hospital account - it's not possible to admit a patient in Epic without specifying where the admission's charges should be collected. HSP_ACCOUNT To report on all hospital encounters attached to a hospital account, use PAT_ENC_HSP.HSP_ACCOUNT_ID to link to ________________. Guarantor The __________ of a hospital account is the person or entity who is ultimately responsible for paying off whatever portion of the hospital account's balance is not paid for by insurance. False - All hospital accounts have exactly one guarantor True or False: A hospital account can have more than one guarantor. False - patient demographics stored in HSP_ACCOUNT, these columns are not populated until the patient is discharged.

True or False: If I am writing a report that will include hospital accounts for patients that are still in- house, I can use HSP_ACCOUNT? Coverage In Epic, a ____________ is defined as a single benefit plan, provided by a single payor, and owned by a single subscriber. CLARITY_EPM (insurance Payors) and/or CLARITY_EPP (Insurance Plans) What two tables do you use to report on Insurance COVERAGE_MEM_LIST What table links Coverage-to-Patient? ACCT_GUAR_PAT_INFO You can report on which guarantors are associated with which patients using the _________________ table. ACCT_COVERAGE To see all of the insurance coverages associated with a guarantor account, you can use the __________ table. As soon as (or before) a patient enters the facility When is a hospital account opened? An account stays open until every charge on the account has been paid, written off, or otherwise accounted for. When is a hospital account closed? DNB (Discharged Not Billed) What is a patient's hospital account's status upon discharge? Billing Status ________ ________ keeps track of where a hospital account is in its lifecycle. Account Class ________ ________ is a custom category list used to group hospital accounts by the type of visit they pertain to. Most facilities have account classes called Inpatient, Outpatient, and Emergency, but the list is customizable. Account Base Class ________ ________ ________ is an Epic-released list of only three values: Inpatient, Outpatient, and Emergency.

Financial Class ________ ________ is a custom category list your facility can define to mark the difference between payors. Categories often include values like Commercial or Medicare. False -The financial class does not change as the balance on the hospital account is billed to secondary coverages or when any residual balance is billed to the guarantor. True or False: The financial class changes as the balance on the hospital account is billed to secondary coverages or when any residual balance is billed to the guarantor. Zero - the hospital account would have a balance of zero, but $10 in total charges and -$10 in total payments. If $10 is charged to a hospital account and then paid off by the guarantor, what would be the Balance of the hospital account? Bucket-Level Bad Debt and Account-Level Bad Debt What are the two ways Epic writes off accounts to Bad Debt? True True or False: Bad Debt is a status indicated by HSP_ACCOUNT.ACCT_BILLSTS_HA_C only when using bucket-level bad debt. Self-Pay ________-________ levels determine the messages guarantors receive on statements, and are an instrumental part of the self-pay portion of the revenue cycle. Billing Indicators You can define and use ________ ________ to indicate something special about the hospital account. Stop Bill A ________ ________ is placed on a hospital account either by the system or manually by an end user to prevent bills or claims from being processed. Recurring Accounts These special types of hospital accounts allow related outpatient visits, such as physical therapy sessions, to be billed together on the same claim. Charges from each encounter in the series will be sent to the same hospital account which can be set to bill after a certain amount of time. Institutional Accounts

These accounts are attached to an institutional guarantor account and serve a specific purpose for billing multiple patients to the same company. For instance, a company might have one of these accounts for its employee drug screenings or flu shots. Combined Accounts There are cases where it is necessary to combine two previous hospital accounts into one. The most prominent example is compliance with the Medicare "three-day rule". Medicare requires related outpatient visit within three days of an inpatient stay be billed on the Inpatient claim. False - Do not use the billing status of "Combined" to identify source accounts as this status will eventually be changed to "Closed." Instead, look for accounts where COMBINE_ACCT_ID is not null. True or False: You should use the billing status of "Combined" to identify source Combined Accounts? True - HSP-ACCOUNT is a no-add single response table making reporting difficult. HSP_HAR_SNAPSHOT table contains detailed information about hospital accounts as of midnight for a given date and allows for more robust reporting. True or False: For Historical Hospital Account Snapshot you should use the HSP_HAR_SNAPSHOT table instead of the HSP_ACCOUNT Table. No. Account class can be expanded per your needs, but only three account base classes exist - Inpatient, Outpatient, and Emergency. Do "account class" and "account base class" refer to the same list of categories? No. TOT_ACCT_BAL will equal zero, but TOT_CHGS will still contain the total amount of charges that were ever placed on the account. For a paid-off hospital account, will HSP_ACCOUNT.TOT_CHGS equal zero? Yes. It reflects the coded time of discharge, which can potentially differ from the clinically documented time of discharge. Can HSP_ACCOUNT.DISCH_DATE_TIME be different from the date and time of discharge found in the patient's chart? No - Only if your organization is using account-level bad debt. Will all delinquent hospital accounts have HSP_ACCOUNT_3.BAD_DEBT_FLAG_YN set to Y? A facility-defined category list that can be used to mark hospital accounts. What is a billing indicator? True True or False: The first time anyone enters the Coding Info activity for a given hospital account, they are asked if they want to start coding the account.

Saying "yes" to this prompt causes the user's ID to be stored in the account and starts a clock which can be used to track the performance of individual coders. True True or False: Much of the information here defaults in from the patient's clinical and ADT documentation (such as their admission date and time, their admitting and attending providers, and their primary service), but any of it can be changed on the hospital account for billing purposes. False - Note that information on this form will not flow backward to the patient's clinical documentation

• if an admission's primary service is changed here, for example, the hospital account and patient records may list different primary services for the stay. True or False: Information on the Coding ADT Info tab can flow backward to the patient's clinical documentation - if an admission's primary service is changed here, for example, the primary service for the hospital account will change also. True True or False: If you need information from a patient's chart (i.e. clinical information) instead of coding information, use PAT_ENC_HSP and its associated tables from the Inpatient and ADT data models. True True or False: In Clarity, diagnoses are stored in the CLARITY_EDG table and can contain ICD-9 or ICD10 codes? Admission Diagnosis The HSP_ACCT_ADMIT_DX table in Clarity stores what type of diagnosis codes? Final Diagnosis The HSP_ACCT_DX_LIST table in Clarity stores what type of diagnosis codes? External Injury Codes The HSP_ACCT_EXTINJ_CD table in Clarity stores what type of diagnosis codes? Procedure Codes The CL_ICD_PX table in Clarity stores what type of codes? True True or False: The Procedures tab allows coders to add ICD and/or CPT procedure codes to a hospital account. ICD-coded procedures The HSP_ACCT_PX_LIST table in Clarity stores what type of codes? CPT and HCPCS-coded procedures