Epic billing system manual

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Resolute

Hospital Billing

Epic 2017

RHB101

RHB101 Resolute Hospital

Billing Fundamentals

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Epic Systems Corporation

1979 Milky Way • Verona, WI 53593 • Voice: (608) 271 -9000 • Fax: (608) 271-7237

www.epic.com

documentation@epic.com

Last Revision: August 11, 2017

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RHB101 Resolute Hospital Billing

Fundamentals

Introduction: Hospital Billing Fundamentals ...................................... 1•3

Introduction to the Hospital Billing Revenue Cycle .......................... 2•3

Linking Records in Registration........................................................... 3•3

Scheduling and Checking In a Patient in an HOD ........................... 4•3

Entering Charges from a Fee Ticket ................................................... 5•3

Correcting and Reviewing Charge Errors .......................................... 6•3

Reporting on Revenue ........................................................................ 7•3

Correcting Prebilling Edits................................................................... 8•3

Combining Consecutive Accounts.................................................... 9•3

Sending Claims ................................................................................. 10•3

Correcting Claim Errors..................................................................... 11•3

Processing Late Charges .................................................................. 12•3

Following Up on Outstanding Claims ............................................... 13•3

Posting Basic Insurance Payments .................................................. 14•3

Managing Denials ............................................................................. 15•3

Resolving Underpayments................................................................ 16•3

Sending Guarantor Statements ........................................................ 17•3

Researching Balance and Statement Inquiries............................... 18•3

Accessing Accounts for Follow-up .................................................. 19•3

Updating Guarantor Information...................................................... 20•3

Updating Coverage Information ...................................................... 21•3

Posting Guarantor Payments ............................................................ 22•3

Managing Credit Balances .............................................................. 23•3

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Reviewing Adjustments ..................................................................... 24•3

Contacting Guarantors about Unpaid Balances............................. 25•3

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Introduction: Hospital Billing Fundamentals 1•1

RHB101 Resolute Hospital Billing Fundamentals Resolute Hospital Billing Epic 2017

Lesson 1: Introduction: Hospital Billing

Fundamentals Introduction.................................................................................................................... 1•3

Prerequisites and Assumptions ................................................................................... 1•3

How to Use This Training Companion......................................................................... 1•3

Certification ................................................................................................................... 1•5

Class Attendance ...................................................................................................... 1•5

Exams .......................................................................................................................... 1•5

Failed Exams............................................................................................................ 1•6

How to Study for Your Epic Exams .......................................................................... 1•6

Project......................................................................................................................... 1•7

Maintaining a Certification ........................................................................................ 1•7

Proficiency .................................................................................................................. 1•8

Contact Information .................................................................................................. 1•8

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1•2 Introduction: Hospital Billing Fundamentals

Resolute Hospital Billing Epic 2017 RHB101 Resolute Hospital Billing Fundamentals

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Introduction: Hospital Billing Fundamentals 1•3

RHB101 Resolute Hospital Billing Fundamentals Resolute Hospital Billing Epic 2017

Introduction: Hospital Billing Fundamentals

Introduction

Welcome to Resolute Hospital Billing Fundamentals! In this class we'll explore the hospital revenue

cycle and the end user features the software supports to address it.

We'll discuss account creation, charge entry, and the charge editing tools in the software. Next we'll

discuss claims processing and claim editing, followed by insurance payment posting. We'll also

touch on guarantor statement processing and guarantor payment posting. For balances that remain

after payment posting we'll address adjustment posting, and self-pay follow-up.

During the class, keep in mind that we'll primarily discuss end user functions, and not

administrative system configuration, which is covered in the Resolute Hospital Billing

Administration class.

Prerequisites and Assumptions

Before undertaking the course of study within this class, it is recommended that you complete pre-

requisite e-learning lessons. The list of lessons is found on the UserWeb Course Catalog.

How to Use This Training Companion

This training companion is intended as a tool for learning the material presented in class. Please use

it as a place for notes on the topics and additional details covered in class.

Recommendations for certification success:

 Practice in the system.

 Take thorough notes during class in your companion.

 Review your companion and lecture notes.

 Review questions at the end of each chapter.

Informative text boxes throughout the companion will draw your attention to content of particular

interest. Here are examples of types of text boxes you might encounter:

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1•4 Introduction: Hospital Billing Fundamentals

Resolute Hospital Billing Epic 2017 RHB101 Resolute Hospital Billing Fundamentals

Critical information for the setup or use of a particular feature. For example: a particular

feature is only available if application X is installed.

Setup information related to the current feature. This provides basic information about the

system build required to get a feature to work properly.

Extra information related to a given topic. You do not need to know this information for

certification.

Foundation System information or recommendations. You do not need to know this

information for certification.

The Foundation System is regularly updated and improved based on lessons learned

and customer feedback. Log in to the Foundation Hosted environment to see our current

setup.

Our documents include Epic's standard copyright statement. Do not remove it.

If you create new materials, include: "This material contains confidential and copyrighted

information of Epic Systems Corporation" whenever that document contains Epic's screen shots or

other content based on our materials. You should also consider adding your own copyright

statement.

Be sure not to post Epic-related e-learning or documentation on an unprotected website that can be

accessed by the general public. This includes both materials that Epic has written and that you have

written.

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Introduction: Hospital Billing Fundamentals 1•5

RHB101 Resolute Hospital Billing Fundamentals Resolute Hospital Billing Epic 2017

Certification

The requirements to achieve certification are listed below for the Resolute Hospital Billing

Administration and Single Billing Office Administration certifications. If you are attending HB

Fundamentals as a pre-req to another certification (such as Resolute Hospital Billing Claims

Administration) then please reference the certification requirements contained in those courses.

Class Attendance

To achieve certification you must attend class at Epic. Attending class at Epic allows you to

network and experience the culture of Epic, all while getting the most up to date and accurate

information about an application directly from an application trainer. You are required to attend:

 RHB101 Resolute Hospital Billing Fundamentals

 REV201 Shared Revenue Administration

 RHB302 Resolute Hospital Billing Administration

Class attendance never expires.

Exams

Certification requires the taking and passing of various exams as a demonstration of content

knowledge. There is one exam per class attended.

Exams:

 RHB101 Resolute Hospital Billing Fundamentals

 NOTE: Use caution when requesting your exam. The Resolute Hospital Billing

Fundamentals for Single Billing Office (RHB102) exam is NOT the correct exam.

 Minimum passing score required is 80%.

 REV201 Shared Revenue Administration

 NOTE: You do not need a proctor for this exam and the exam can be taken an unlimited

number of times without returning to class.

 Minimum passing score required is 80%.

 RHB302 Resolute Hospital Billing Administration

 NOTE: Use caution when requesting your exam. The Resolute Hospital Billing

Administration for Single Billing Office (RHB303) exam is NOT the correct exam.

 Minimum passing score required is 80%.

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1•6 Introduction: Hospital Billing Fundamentals

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All exams are formatted to be True/False or Multiple Choice questions only. You can see an

example of this format at the end of each chapter in this book (the Reviewing the Chapter - Review

Questions section). All questions are worth one (1), three (3), or five (5) points each unless

otherwise noted for that exam. The higher the point value the more challenging the question. Five

point questions are almost entirely scenario based questions, which require providing multiple

responses. Exams are proctored and have a two (2) hour time limit unless otherwise noted per

exam.

Score expiration

If you pass an exam the score is valid to be used toward achieving certification for a limited time. If

you do not finish your certification before the expiration date your exam score will no longer be

valid. For exam expiration dates, follow these steps:

1. Go to the User Web.

2. Click the Training Home link along the left-hand side in the Training section (scroll down if

necessary).

3. Expiration dates are along the right-hand side in the Important Dates Section.

Failed Exams

There are considerations on the number of times you can fail an exam. Please consider, and verify

your understanding of, these considerations before you take your first exam.

 All exam attempts you make are tracked by exam, regardless of version.

 After your third (3rd) fail on an exam you must return to Epic and retake the associated class

before you can make another attempt to pass that exam. This attendance is considered refresher

training.

 If you fail the same exam five (5) times you must return to Epic and retake the associated class

before you can make another attempt to pass that exam. This training is not considered

refresher training and will be charged to your organization.

 Every subsequent failing score beyond five (5) fails will require re-attendance at Epic for the

associated class before you can make another attempt to pass the exam.

 The limitations described above will be enforced into the future.

This limit is also documented in Epic's Training Guide - Epic Community Member and Epic's

Training Guide - Consultant on the UserWeb.

How to Study for Your Epic Exams

https://documentation.epic.com/Redirect.aspx?DocumentID=2904903&Version=Epic%202017

https://documentation.epic.com/Redirect.aspx?DocumentID=2904905&Version=Epic%202017

https://documentation.epic.com/Redirect.aspx?DocumentID=2904905&Version=Epic%202017

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Introduction: Hospital Billing Fundamentals 1•7

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Whether you have recently taken exams or have not taken an exam in quite some time, you will

want to make sure that your study techniques will work for your long-term learning.

To that end, Epic training has developed a piece of documentation, How to Study for Your Epic

Exams that you can access through Galaxy or through the hyperlink.

Project

You are required to complete one project for the Resolute Hospital Billing Administration

certification. The project details will be introduced in your Administration class as the project

cannot be started until after that class.

Project Grading:

You will receive a score back within three business days of submitting as well as the high-level

areas where you missed points. You may resubmit your project for a higher score considering the

following rules:

 You are limited to a total of two (2) submissions per day, per project.

 Plan your project build against your personal certification deadlines before starting the

project.

 You are expected to fully troubleshoot before submitting your project.

Score expiration

If you pass a project, the score is valid to be used toward achieving certification for a limited time. If

you do not finish your certification before the expiration date your project score will no longer be

valid. For expiration dates, follow these steps:

1. Go to the User Web.

2. Click the Training Home link along the right-hand side in the Training section (scroll down if

necessary).

3. Expiration dates are along the right-hand side in the Important Dates Section.

Maintaining a Certification

With each software update we update the version of the available certifications as well. It is

required that you maintain your certification to the most current version, regardless of the version

your organization uses. Maintaining certification is done through the Continuing Epic Education

process, by which you will demonstrate your application knowledge using the following:

https://documentation.epic.com/Redirect.aspx?DocumentID=3208594&Version=Epic%202017

https://documentation.epic.com/Redirect.aspx?DocumentID=3208594&Version=Epic%202017

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1•8 Introduction: Hospital Billing Fundamentals

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1. New Version Training - requires reading an overview of the new features for an application

and passing a short, non-proctored quiz. This is required with every Epic release and should

take an hour or less per NVT.

2. Application Essentials Assessment - take and pass a one-hour assessment covering the core

concepts of the certification, reinforcing knowledge of the concepts currently in the

certification. You will be required to do this approximately every five years (or about three Epic

versions). Expect 6-8 hours of time required to review material and complete the assessment.

Where do you stand with your requirements? For each version you will automatically receive an

email from Epic detailing what you are required to do and the deadlines for completing those

items. Your organization is also notified and tracking your progress.

If you do not complete your Continuing Epic Education requirements your certification will

lapse. This means you are no longer certified. If your certification lapses you can regain it

by retaking and passing all certification exams. Please see Epic's Training Guide - Epic

Community Member on the UserWeb for details on regaining lapsed certifications.

Alternatively, if you are a consultant, view the Epic's Training Guide - Consultant.

Proficiency

Proficiency allows trainees to self-study the materials and demonstrate a lower threshold of content

knowledge. All requirements are the same as certification except for the following:

 Attendance at Epic is not required

 Minimum scores to pass are reduced by 10%

Continuing Epic Education requirements are the same for certified and proficient individuals.

Please reference the following information about Proficiency before attempting to complete

a Proficiency:

Steps to Attain Proficient Status

Contact Information

The table below provides you with contact information you may need during your certification

process:

Contact Used For

https://documentation.epic.com/Redirect.aspx?DocumentID=2904903&Version=Epic%202017

https://documentation.epic.com/Redirect.aspx?DocumentID=2904903&Version=Epic%202017

https://documentation.epic.com/Redirect.aspx?DocumentID=2904905&Version=Epic%202017

https://documentation.epic.com/Redirect.aspx?DocumentID=2905642&Version=Epic%202017

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Introduction: Hospital Billing Fundamentals 1•9

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Contact Used For

hospitalbillingtrainingsubmissions@epic.com The vast majority of your questions should be

directed to this email address. This will connect

you with the HB trainers who can answer your

questions on anything related to billing. All

requests for concept clarification, practice

patient lists, or user login information should be

directed to this email address and not to the

certification environments or UserWeb

addresses listed below. If you aren't sure about

who to contact, use one of these email addresses.

epicaccess@epic.com Use this only if your access specifically to the

certification environments is broken or lost. If

you can access the certification environments

but are having trouble logging in to Hyperspace

contact the training teams directly instead.

userwebaccounts@epic.com Use this only if your access to specifically the

UserWeb is broken or lost. If you have a

question regarding billing contact the training

team directly instead.

Direct email for your Epic representative (either

the implementers or your technical services

representative)

You can find this information by asking a

member of your own project team or by asking

the training teams listed above.

Exam Reviews...Reply All to your exam score

email.

For all exam reviews. This will route to the

appropriate parties who will in turn contact you

to set up a time to discuss the content you

missed.

exams@epic.com Use this to ask questions about requesting,

submitting, or taking exams, as well as proctors

for those exams.

registrations@epic.com Use this to ask questions about registering for

classes at Epic.

mailto:hospitalbillingtrainingsubmissions@epic.com

mailto:epicaccess@epic.com

mailto:userwebaccounts@epic.com

mailto:exams@epic.com

mailto:registrations@epic.com

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1•10 Introduction: Hospital Billing Fundamentals

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Contact Used For

training@epic.com Use to inquire about the status of your paper

certification or NVT stickers.

mailto:trainingadminteamsubmissions@epic.com

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Introduction to the Hospital Billing Revenue

Cycle

2•1

RHB101 Resolute Hospital Billing Fundamentals Resolute Hospital Billing Epic 2017

Lesson 2: Introduction to the Hospital

Billing Revenue Cycle Introduction to Hospital Billing....................................................................................... 2•3

By the End of This Lesson, You Will Be Able To... ........................................................ 2•3

In-Class Activity ............................................................................................................. 2•4

Reviewing the Standard Revenue Cycle .................................................................. 2•4

Hospital Account Creation..................................................................................... 2•5

Charge Generation ................................................................................................ 2•5

Discharged-Not-Billed ............................................................................................. 2•6

Initiate Billing............................................................................................................ 2•6

Claims Processing and Insurance Payment Posting.............................................. 2•6

Statement Processing and Guarantor Payment Posting ...................................... 2•6

Closed Accounts .................................................................................................... 2•7

Buckets .................................................................................................................... 2•7

Reviewing Errors throughout the Revenue Cycle ..................................................... 2•9

Reviewing the Chapter................................................................................................ 2•11

Review Questions ..................................................................................................... 2•11

Review Key ............................................................................................................... 2•14

Study Checklist ......................................................................................................... 2•17

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2•2 Introduction to the Hospital Billing Revenue

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Introduction to the Hospital Billing Revenue

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2•3

RHB101 Resolute Hospital Billing Fundamentals Resolute Hospital Billing Epic 2017

Introduction to the Hospital Billing Revenue Cycle

Introduction to Hospital Billing

The purpose of this chapter is to introduce you to Epic's Hospital Billing revenue cycle, the tools

used to accomplish billing objectives, and key vocabulary used in Hospital Billing.

For more information, view the following e-learning module, available through

WeLearning:

RHB003 Resolute Hospital Billing Revenue Cycle Overview

By the End of This Lesson, You Will Be Able To...

 Describe the revenue cycle

 Define key terms of the revenue cycle

 Define all hospital account statuses

 Define all bucket statuses

 Describe which tools are used to find errors throughout the revenue cycle

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2•4 Introduction to the Hospital Billing Revenue

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In-Class Activity

Reviewing the Standard Revenue Cycle

Across healthcare organizations, the billing process is similar. The ultimate goal is to charge for the

services provided and then receive payment for those services from the patient's insurance

company (if applicable) and the guarantor. Resolute Hospital Billing is built to handle the key

components of the revenue cycle, while incorporating additional functionality for ease of use and

better resolutions in billing.

The following are some frequently asked questions that may help you understand Hospital Billing

a little better.

1. What is the purpose of Hospital Billing and where is it used?

 Hospital Billing is how we bill for the services provided and resources used by patients at a

hospital. Hospital Billing charges are often called technical charges. Most of the time,

Hospital Billing is only used in a hospital setting.

2. Is Hospital Billing how we bill for physicians?

 While it is possible, we typically do not bill for physicians using Hospital Billing. Fees for a

physician's time and expertise - often called professional fees - are billed through

Professional Billing. Professional Billing is most often used in a clinic setting. Physicians

working in a hospital setting are often part of a medical group, which uses Professional

Billing to reimburse the physicians.

3. What is Accounts Receivable?

 Accounts Receivable (or A/R) refers to a facility's outstanding dollars that are due from

patients, insurance companies, third-party payors, etc. These dollars are most often

categorized and aged by payor, third-party, and patient.

The following diagram depicts the revenue cycle in an error-free scenario.

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Introduction to the Hospital Billing Revenue

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Key Term Definition

HAR STORES CHARGES, PAYMENTS, AND ADJUSTMENTS FOR A

HOSPITAL ENCOUNTER

Min Days MINIMUM NUMBER OF DAYS BETWEEN DISCHARGE AND

INITIATE BILLING

Initiate Billing THE POINT IN THE REVENUE CYCLE WHEN WE ATTEMPT TO

BILL THE HAR

Hospital Account Creation

The revenue cycle begins the moment a hospital account is created during preadmission,

admission, appointment scheduling, or check-in. A patient must have a hospital account to be

admitted or checked in. This hospital account holds all hospital charges, payments, and

adjustments for the encounter. When the hospital account exists and while the patient is admitted,

the status of the HAR is Open.

Charge Generation

Technical charges can be filed to a HAR as soon as it exists. Most charges occur while the patient is

in the hospital (HAR status = Open), but they can also appear on the HAR after the patient is

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2•6 Introduction to the Hospital Billing Revenue

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discharged (HAR status = DNB). Charges are considered Late Charges if they are posted after the

HAR is Billed.

Discharged-Not-Billed

After a patient is discharged the hospital account status changes from Open to DNB (Discharged-

Not-Billed).

One of the important tasks that typically occurs while the account is in a DNB status is coding.

Coding is the identification of the diagnosis and the procedures that were performed while the

patient was at the hospital. Because this information is not always available immediately at

discharge, we wait a pre-determined number of days before attempting to bill the account so that

coding can occur. This period of time is known as min days. Min days is defined by your

organization and can differ by scenario.

Initiate Billing

After the initial account has been held for min days, the system attempts to bill the account through

an automated process known as Initiate Billing. During Initiate Billing, the account is evaluated

against a series of checks to make sure all necessary information is present and the account is

eligible to be billed. The checks are known as DNB checks. If an account successfully passes these

checks, the status changes to Billed. Accounts that do not pass the checks are held in a DNB status

and routed to the appropriate users for follow-up.

DNB checks can also be run at the time of discharge. This would allow users to begin following up

on account issues sooner. The decision to run DNB checks at discharge is configured for each

individual DNB check.

Claims Processing and Insurance Payment Posting

A billed account that has an associated coverage goes through claims processing. Claims processing

is an automated process that evaluates accounts against checks in an attempt to generate a claim.

These checks are known as claim edits. Accounts that pass claim edit checks produce clean claims

that are sent to a clearinghouse, external scrubber, or payor. Claims with errors are sent to the error

pool to be fixed before they are sent to the payor.

When remittance advice and payments are received from a payor, they are posted into the system

either manually or electronically.

Statement Processing and Guarantor Payment Posting

After the insurance payment is posted, the remaining balance is moved on to the next responsible

party. If there is a secondary payor on the hospital account, the system produces a secondary claim.

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Introduction to the Hospital Billing Revenue

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When the balance moves to self-pay, the guarantor becomes eligible for a statement. When a

guarantor payment is received, through mail, Welcome, or MyChart, it is posted to hospital

accounts either manually or through lock-box remittance.

Closed Accounts

Once the balance of the account is $0, the hospital account has finished its journey through the

Revenue Cycle, and it now has a status of Closed.

Buckets

How are buckets used in the revenue cycle?

THEY ASSIGN AND TRACK FINANCIAL LIABILITY FOR AN HB HAR

There are various parties that might be responsible for a patient's medical expenses, such as

insurance or the guarantor. Buckets are used to assign and track financial liability for a HAR. The

three most common types of buckets are:

1. Pre-billed - holds charges before they are assigned to another bucket.

2. Insurance - holds charges, payments, and adjustments assigned to a specific insurance.

3. Self-pay - holds charges, payments, and adjustments assigned to the guarantor.

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2•8 Introduction to the Hospital Billing Revenue

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Pre-billed and self-pay buckets are created as soon as the HAR exists. Insurance buckets are created

when liability is assigned to that insurance. This happens either during initiate billing (for the

primary insurance) or when a balance is moved to the next responsible party.

Like the HAR, buckets have statuses.

Bucket status Description

Created All buckets start in this status. No communication with the entity that

owes has been made.

Outstanding Balance of that bucket has been communicated. For insurance buckets this

means the claim was accepted in Epic. For self-pay buckets the balance is

on an accepted statement.

Closed No balance exists on the bucket.

Other buckets and bucket statuses exist, but are not commonly used. Examples include the

Undistributed bucket (for undistributed payments directly attached to the HAR) and the Rejected

and Replaced bucket statuses.

The assignment of financial liability typically flows in a very linear fashion in the revenue cycle: the

outstanding balance moves from pre-billed to insurance (if appropriate) to self-pay. In some

circumstances though, the assignment needs to flow backwards. This backward flow of liability is

known as "undo billing" (or "undo transfer" in situations where multiple buckets exist). If the action

of undo billing is performed on a bucket, the bucket status changes from its previous status to

Rejected and charges will return to the pre-billed bucket.

When are buckets created?

PREBILLED__________ and SELF-PAY_____________buckets are automatically created

when the HAR is created. When Initiate Billing is successful and there is a coverage

record valid for the encounter, the INSURANCE____________ bucket is created.

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Introduction to the Hospital Billing Revenue

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Review: The three most common bucket statuses are:

CREATED

OUTSTANDING

CLOSED

Reviewing Errors throughout the Revenue Cycle

Though the previous diagram shows an error-free revenue cycle, Epic is prepared to handle many

different problems that can arise in the business office. From the initial preadmission to guarantor

follow-up, tools exist to help users expedite the billing process.

The following diagram depicts the revenue cycle and the tools Epic has designed to catch hospital

accounts that contain errors. Each of these tools will be defined in the diagram below, but more

detail on how they are used will be discussed in later chapters.

Workqueue

PLACE TO FOLLOW UP ON HARS, CLAIMS, AND TRANSACTIONS WITH ISSUES

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2•10 Introduction to the Hospital Billing Revenue

Cycle

Resolute Hospital Billing Epic 2017 RHB101 Resolute Hospital Billing Fundamentals

DNB Checks

A FORM OF ERROR CHECKING APPLIED BY THE SYSTEM. AUTOMATICALLY RUN

AT INITIATE BILLING, CAN ALSO BE RUN AT DISCHARGE

Stop Bill

HOLDS ACCOUNT IN REVENUE CYCLE; CAN BE PLACED MANUALLY BY USER

OR AUTOMATICALLY BY SYSTEM. TAKES EFFECT AT THREE PLACES: INITIATE

BILLING, CLAIMS PROCESSING, STATEMENT PROCESSING

Follow-up Record

USED TO FOLLOW UP ON INSURANCE DENIALS, OVERPAYMENTS, AND

UNDERPAYMENTS. IS ASSOCIATED WITH A SPECIFIC INSURANCE BUCKET.

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Reviewing the Chapter

Review Questions

1. What holds the hospital charges for a hospital-based encounter?

A. Guarantor account

B. Coverage record

C. Hospital account

2. True or False: All liability buckets are created when you initiate billing on the hospital account.

3. Which of the following is the best description of a DNB check? (Select one answer)

A. HAR edit checks that are evaluated either when the patient is discharged or when initiate

billing is attempted.

B. Charge review edit checks.

C. Claim edit checks.

D. Self-pay edit checks.

4. What happens to any hospital account that fails a DNB check? Choose all that apply.

A. Initiate billing cannot be completed.

B. Account remains in status of DNB

C. Account status changes to Billed

D. Account is routed to an account workqueue

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5. What is the status of this hospital account?

A. Open

B. Created

C. DNB

D. Outstanding

E. Billed

F. Closed

6. What is the status of this hospital account?

A. Open

B. Created

C. DNB

D. Outstanding

E. Billed

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F. Closed

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2•14 Introduction to the Hospital Billing Revenue

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Review Key

1. What holds the hospital charges for a hospital-based encounter?

A. Guarantor account

B. Coverage record

C. Hospital account

C. Hospital account

2. True or False: All liability buckets are created when you initiate billing on the hospital account.

False. The Self-pay and Pre-billed buckets are created when the hospital account is created. The primary

insurance bucket is created when you initiate billing. Non-primary insurance buckets are created after an

NRP (next responsible party) action performed on the previous insurance bucket.

3. Which of the following is the best description of a DNB check? (Select one answer)

A. HAR edit checks that are evaluated either when the patient is discharged or when initiate

billing is attempted.

B. Charge review edit checks.

C. Claim edit checks.

D. Self-pay edit checks.

A. HAR edit checks that are evaluated either when the patient is discharged or when initiate billing is

attempted.

4. What happens to any hospital account that fails a DNB check? Choose all that apply.

A. Initiate billing cannot be completed.

B. Account remains in status of DNB

C. Account status changes to Billed

D. Account is routed to an account workqueue

A,B,D

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5. What is the status of this hospital account?

A. Open

B. Created

C. DNB

D. Outstanding

E. Billed

F. Closed

E. Billed.

There is an outstanding self -pay bucket, which means the hospital account must be in a Billed status.

6. What is the status of this hospital account?

A. Open

B. Created

C. DNB

D. Outstanding

E. Billed

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F. Closed

E. Billed

This hospital account is also billed. The created insurance bucket means the hospital account made it through

the Initiate Billing process successfully, which means it can't be Open or DNB.

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Study Checklist

Make sure you can define the following key terms:

 Hospital Account

 Min Days

 Buckets

 Accounts Receivable

 Follow-up Records

Make sure you fully understand and can explain the following concepts:

 HAR statuses

 Bucket Statuses

 Workqueues

 Stop Bills

 DNB Checks

 Bad Debt

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Linking Records in Registration 3•1

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Lesson 3: Linking Records in

Registration Linking Records in Registration...................................................................................... 3•3

By the End of This Lesson, You Will Be Able To... ........................................................ 3•3

The Big Picture................................................................................................................ 3•4

In-Class Activities .......................................................................................................... 3•5

Task: Log into Hyperspace ......................................................................................... 3•5

Task: Use Patient Station to Access a Pending Admission ........................................ 3•5

Task: Add Information to a Patient Record ............................................................... 3•6

Enter Patient Demographics .................................................................................. 3•6

Short Cut Keys...................................................................................................... 3•7

Enter a Patient's Contacts ...................................................................................... 3•7

Task: Create a Guarantor Record ............................................................................. 3•7

Create a New Guarantor Account ....................................................................... 3•7

Task: Create a Coverage Record ............................................................................. 3•8

What is a coverage record? .................................................................................. 3•8

Components of Hyperspace ..................................................................................... 3•9

Hyperspace Components ...................................................................................... 3•9

Task: Enter Admission and Provider Information...................................................... 3•10

Task: Create a Hospital Account ............................................................................. 3•11

Complete an Admission........................................................................................... 3•12

After-Class Exercises ................................................................................................... 3•13

Activity 1 - Admit a Patient ...................................................................................... 3•13

Create a Guarantor Account .............................................................................. 3•13

Create a Coverage.............................................................................................. 3•14

Complete the Encounter Specific Forms ............................................................. 3•14

Activity 2 - Discharge an Admitted Patient............................................................. 3•15

Reviewing the Chapter................................................................................................ 3•16

Review Questions ..................................................................................................... 3•16

Review Key ............................................................................................................... 3•18

Study Checklist ......................................................................................................... 3•20

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Linking Records in Registration

Linking Records in Registration

By the End of This Lesson, You Will Be Able To...

 Find an existing patient record through Patient Station

 Create a Patient Record

 Create a Guarantor Record

 Create a Coverage Record

 Record encounter level information

 Create a hospital account

 Explain how the patient record, guarantor record, coverage record, and hospital account are

linked

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The Big Picture

During the admission or pre-admission processes, an admission clerk links together the necessary

records for appropriately billing the insurance and guarantor. In this chapter, we'll examine the

different records that can be linked at registration.

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In-Class Activities

Preadmission is the process of gathering important information prior to a patient's arrival at the

hospital. Epic's preadmission workflow allows you to gather demographic, billing, and insurance

data for a patient in advance of the patient's arrival. Also, the manual creation of the patient's

Hospital Billing Account is part of this workflow.

In this lesson, we will log in as an admission clerk and admit Lorelai. During this

admission process, you will link the necessary records for appropriate billing. We will

find Lorelai's admission and gather the missing information.

Task: Log into Hyperspace

1. Login as an admission clerk:

 User ID: adtpa

 Password: epic

2. Press ENTER.

3. Confirm your department is EMH Admitting by pressing ENTER.

Task: Use Patient Station to Access a Pending Admission

Patient Station neatly displays all encounters for a patient. Some users will also be able to create

new patients directly.

1. Select Patient Station in your Hyperspace toolbar.

 Keyboard shortcut: CTRL + 1

2. In the Name/MRN field search for "<Your Theme Last Name>, Lorelai".

 Your Assigned Last Name can be found on your Classroom Information Sheet.

3. Click Find Patient.

4. Click Select.

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5. DOUBLE-CLICK Lorelai's pending admission.

There are times when searching just by patient name and date of birth won't work, as that

information may not be available. Patient lookup fields can also reference the following

shortcuts. Note that not all shortcuts listed make sense for all users.

Look up by... Shortcut to use

Insurance ID number IN.####

Member ID number MI.####

Phone Number PH.####

Contact Serial Number CSN.####

Hospital Account Number HAR.####

Task: Add Information to a Patient Record

The New Patient Wizard is an activity that presents a guided workflow for entering basic

registration information for a new patient. This information is stored in the patient record. There

should be only one patient record per patient in Epic.

Enter Patient Demographics

We call Lorelai to enter the rest of her information. She lives at 4565 Lake Street in

Madison, WI (ZIP code is 53702).

1. Click to edit the current address (which is blank) or create a new one.

2. Enter Lorelai's street address "4565 Lake St" and press TAB.

3. Enter "53702" in the City (or ZIP) field and press TAB.

4. She is married, so indicate that in the Marital Status field

5. Click in the Preferred language field.

 The magnifying glass icon indicates that you have a list of values to select from.

6. Select "English".

7. Enter "Very Good" in the Form confidence field.

8. Navigate to the Patient Contacts form.

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Short Cut Keys

CTRL + ENTER To see available choices in Selection List fields.

CTRL + Click To view item information

ALT + [Underlined

Letter]

To select the button.

Enter a Patient's Contacts

Lorelai would like her husband, Luke, listed as an emergency contact.

1. Click Add in the Patient Relationships section

2. Enter "Danes, Luke" in the Name field.

3. Locate the Patient Link section in the upper right.

4. Click Pull Info.

5. Enter "Spouse" in the Rel to patient field.

6. Click Accept.

7. Go to the Account Questionnaire form.

Task: Create a Guarantor Record

A guarantor is the person or entity who is financially responsible for a patient. A guarantor account

is a record in Epic that stores information about a guarantor, such as the guarantor's name and

address.

 Every patient needs to have at least one guarantor account before being admitted.

 One patient may have multiple guarantor accounts.

 Guarantor Accounts do not hold insurance information in Epic.

Create a New Guarantor Account

1. Click Create New Account.

2. In the Address Link field confirm "Yes "is entered.

a. Click Accept to copy patient address to guarantor.

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3. Click Next.

Task: Create a Coverage Record

A coverage record holds insurance information for a patient. This record in Epic is the unique

combination of three things:

1. Payor

2. Plan

3. Subscriber

Coverage records are re-used in Epic anytime you need to represent those three things (within the

proper effective dates). Note that in Epic there are no self-pay coverages. The lack of a coverage

record for a patient indicates self-pay.

What is a coverage record?

Coverages...

 Must have one SUBSCRIBER

 May have unlimited MEMBERS

You ask Lorelai if she has insurance. She tells you she has Aetna insurance and that her

card lists her as the subscriber.

1. Enter "Aetna" in the search field and press ENTER.

2. DOUBLE-CLICK the line with Aetna in the Payor and Plan columns.

3. Indicate Lorelai is the subscriber.

4. Enter the following information:

 Group number: 50010

 Subscriber ID: 560911647

5. Click Send.

6. Click Admission.

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 You are on the Interactive Face Sheet in the Admission workflow. This form displays a

summary of registration information and provides links for editing registration

information.

7. Click the Response Received button.

 This button appears at the bottom of Hyperspace when a response to the Eligibility Query

has been received.

8. In the Create New Coverage section, make sure the guarantor account that the coverage should

be linked to is highlighted.

 Since Lorelai only has one guarantor account, it is automatically selected.

9. Click Create Coverage in the bottom right-hand corner of the screen.

10. From the Plan Select window, DOUBLE-CLICK the line with Aetna in the Plan column.

Components of Hyperspace

Before moving on, learn the different components of Hyperspace. Read the following descriptions

and then write the number of the component in the corresponding box on the screenshot above.

Hyperspace Components

1. Hyperspace Title Displays basic information about your Hyperspace session, such as the

department you logged into.

2. Epic Button Contains menus that are available to you, such as Reports and Tools.

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Select a menu to access the options on it.

3. Workspace Tabs Tabs, such as the Workqueue List and Your Assigned Last Name,

Kaviram, are linked to active workspaces. Each workspace you open

generates a tab. Select the tab of an open workspace to go to that

workspace. Click the X to close the workspace.

4. Hyperspace

Toolbar

Lists the menu options most frequently accessed by a user. In addition to

buttons for your most common workflows, it includes the Print and Log

Out buttons.

5. Patient Header Displays information about the current workspace and patient.

6. Activity Tabs Tabs, such as Form Reprints, and Event Management that allow you to

access other activities related to the activity you have open.

7. Activity Toolbar Provides buttons, such as PCP and MSPQ, to accomplish tasks related to

the current activity.

8. Form Navigator Displays a list of forms within the current activity. Select a form in the

Form Navigator to go to that form.

9. Form Pages of fields in which you can enter or view data. Some forms are view

only.

10. Sidebar Checklist Shows the verification checklist so staff can verify patients, guarantors,

coverages, and more from anywhere in the workflow.

Task: Enter Admission and Provider Information

Use the Encounter Info form to enter information about the patient's hospital stay.

1. Click on the Encounter Info form.

2. Enter the following information:

 Point of origin: Physician or Clinic Office

 Private Encounter?: No

 Accident related?: No

 Admission Type: Elective

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 Free Text Diagnoses: Type anything in this field

3. Move to the Accommodations form.

 Enter an Admission date of "T".

 Enter an Admission time of "N".

4. Enter "TRN HB Pool Room" in the Room field if it isn't selected already.

5. Move to the Hospital Accounts form.

Task: Create a Hospital Account

A hospital account records all of the hospital charges, payments, and adjustments for the encounter.

The hospital account also determines which coverage is sent claims for the encounter, and which

guarantor receives a bill for any balance not covered by insurance. Every hospital encounter must

have a hospital account.

Why are hospital accounts important?

 CONTAIN CHARGES, PAYMENTS, AND ADJUSTMENTS FOR THE

ENCOUNTER

 ASSIGN THE GUARANTOR

 ASSIGN THE PAYOR(S) TO BILL

Hospital Account Linking

Must be linked to: ONE PATIENT RECORD, ONE GUARANTOR ACCOUNT

Can be linked to: NONE OF THE PATIENT'S COVERAGES, SOME OF THE PATIENT'S

COVERAGES, ALL OF THE PATIENT'S COVERAGES

1. Before clicking Create New Account, verify Lorelai has a Patient Class of "Inpatient" and a

Guarantor of "P/F".

 Patient Class describes the type of hospital stay that the patient will have. It is a way of

grouping patients, especially for patient access workflows. It is used for error checking,

driving hospital account recommendation, and can be one factor in determining the bed

charge that posts. For preadmissions linked to surgery cases, the patient class pulls in from

the surgical case.

 The Guarantor acct type field determines which type of guarantor account will be linked to

the hospital account.

2. Click Create New Account.

3. Move to the Coverage Info form.

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Complete an Admission

1. Click to expand the Sidebar Checklist.

2. Click Verify to verify the patient.

3. Click the remaining Verify buttons to verify all records for the patient.

4. If a Confirmation Messages window appears:

 Use the links to move to the forms and fix the problems.

 Click Verify to verify that you fixed the registration.

5. Click Admit.

 Click Continue to move past any warnings that you receive.

 You return to Patient Station for Lorelai.

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After-Class Exercises

Activity 1 - Admit a Patient

After admitting Lorelai , you continue to admit patients. You need to enter information

for Susanna.

1. Click Patient Station in your Hyperspace toolbar.

2. In the Name/MRN field search for <Last Name>, Susanna.

3. Click Find Patient.

4. From the Patient Select window, click Select to open Patient Station for your Susanna.

5. To open the Grand Central New Patient Wizard and collect information from Susanna,

DOUBLE-CLICK on the Pending Admission line.

6. You are on the Demographics form.

You call Susanna's home phone number. She answers and tells you she has time to be

registered for surgery.

7. Enter a street address.

8. Enter a ZIP code and press TAB.

9. Enter a phone number in the Home Phone Number field.

10. Enter an E-mail address.

11. Complete the fields in the General Information section.

12. Move to the Patient Contacts form.

13. Add "Champion, Physician" as Susanna's PCP.

14. Add Susanna's husband, Dale, as an emergency contact. Use the Pull Info button to pull

address information from Susanna and complete the rest of the fields manually.

15. Enter Susanna's Employer "Home Improvements" and her Employment status "Full Time".

16. Move to the Additional Demographics form.

17. Select "No" in the Visually impaired and Hearing impaired fields.

18. In the Preferred communication field, select the No preference option.

19. Navigate to the Account Questionnaire form.

Create a Guarantor Account

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Susanna will be responsible for any balance not covered by insurance.

1. Verify that the Personal/Family and Self options are selected.

2. Click Create New Account.

3. Navigate to the Coverage Selection form.

Create a Coverage

You ask Susanna if she has insurance. She tells you she has Aetna insurance. You ask

her to take out her insurance card.

1. Enter "Aetna" in the search field and click the search button.

2. DOUBLE-CLICK the line with "Aetna" in the Payor and Plan fields.

3. Select Susan as the subscriber.

 You are on the Eligibility Query form.

4. Enter a Group number and Subscriber ID.

5. Click Send.

 You are on the Summary form.

6. Click Preadmit or Admission.

 You are on the Interactive Face Sheet.

7. Click the Response Received button at the bottom of Hyperspace.

8. Click Create Coverage.

 You are on the Interactive Face Sheet.

9. Select the line with Aetna in both the Payor and Plan columns.

Complete the Encounter Specific Forms

1. Move to the Encounter Info form.

2. Enter the following information:

 Expected time: 2:00 PM

 Point of origin: Physician or Clinic Office

 Accident related?: No

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 Private Encounter?: No

 Admission Type: Elective

 Free Text Diagnoses: "influenza"

3. Move to the Accommodations form.

 Enter "TRN HB Pool Room" in the Room field.

4. Navigate to the Provider Info form.

5. Select "Physician, Champion" in the Referral source field.

6. Move to the Hospital Accounts form.

7. Click Create New Account.

8. Use the Sidebar Checklist to verify all of Susanna's records.

 If any error messages appear, click the link to move to the form and fix the problem. Then,

try again.

9. Click Admit.

Activity 2 - Discharge an Admitted Patient

Lorelai suddenly needs to be discharged.

1. From Patient Station, select Lorelai's Admission and click the Discharge button located in the

middle of your screen.

2. Enter a discharge date of today and a discharge time of now.

3. Enter a Discharge Disposition of "Home or Self Care".

4. Click the Discharge button, located in the bottom right portion of your screen.

 Bypass any warning messages you receive.

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Reviewing the Chapter

Review Questions

1. Which keyboard command allows you to see the list of choices available for a field with a

selection list in Hyperspace? Choose only ONE answer.

A. F7

B. F2

C. Ctrl+Enter

D. F9

2. True or False: When a letter in the title of a button is underlined you can select the button by

holding down the ALT key and pressing the underlined letter.

3. Which one of the following is responsible for any balance not covered by insurance? Choose

only ONE answer.

A. Patient

B. Subscriber

C. Guarantor

D. Member

4. True or False: One patient can only be linked to one guarantor account.

5. True or False: A guarantor account is a record that holds insurance information for a patient.

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6. Which of the following statements are true about setting the Address link? field on the

Guarantor Info form to "Yes"? Choose only ONE answer.

A. It links the patient address to the guarantor address

B. It links the guarantor address to the subscriber address

C. It links the patient address to the subscriber address

D. It links the guarantor employer to the patient employer

7. Which of the following best describes the purpose of coverage records? Choose only ONE

answer.

A. They store information needed to send a bill for balances not covered by insurance.

B. They store information about where to send claims.

C. They store information about where to send appointment reminders.

D. They house all of the charges, payments, and adjustments for a hospital stay.

8. True or False: One coverage can have multiple subscribers.

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Review Key

1. Which keyboard command allows you to see the list of choices available for a field with a

selection list in Hyperspace? Choose only ONE answer.

A. F7

B. F2

C. Ctrl+Enter

D. F9

C) Ctrl+Enter

2. True or False: When a letter in the title of a button is underlined you can select the button by

holding down the ALT key and pressing the underlined letter.

True

3. Which one of the following is responsible for any balance not covered by insurance? Choose

only ONE answer.

A. Patient

B. Subscriber

C. Guarantor

D. Member

C) Guarantor

4. True or False: One patient can only be linked to one guarantor account.

False

5. True or False: A guarantor account is a record that holds insurance information for a patient.

False

6. Which of the following statements are true about setting the Address link? field on the

Guarantor Info form to "Yes"? Choose only ONE answer.

A. It links the patient address to the guarantor address

B. It links the guarantor address to the subscriber address

C. It links the patient address to the subscriber address

D. It links the guarantor employer to the patient employer

A) It links the patient address to the guarantor address

Ep icU

UI D:

3E 79

42 EB

-1E C4

-44 8D

-80 52

-47 34

01 ED

89 25

Linking Records in Registration 3•19

RHB101 Resolute Hospital Billing Fundamentals Resolute Hospital Billing Epic 2017

7. Which of the following best describes the purpose of coverage records? Choose only ONE

answer.

A. They store information needed to send a bill for balances not covered by insurance.

B. They store information about where to send claims.

C. They store information about where to send appointment reminders.

D. They house all of the charges, payments, and adjustments for a hospital stay.

B) They store information about where to send claims.

8. True or False: One coverage can have multiple subscribers.

False

Ep icU

UI D:

3E 79

42 EB

-1E C4

-44 8D

-80 52

-47 34

01 ED

89 25

3•20 Linking Records in Registration

Resolute Hospital Billing Epic 2017 RHB101 Resolute Hospital Billing Fundamentals

Study Checklist

Make sure you can define the following key terms:

 Guarantor

 Guarantor account type

 Subscriber

 Coverage

 Hospital Account

 Patient class

Make sure you can perform the following tasks:

 Label the components of Hyperspace

 Enter patient demographic information

 Recognize fields with a selection list

 Pull information from another record

 Create a new guarantor account

 Create a new coverage

 Create a hospital account

Make sure you fully understand and can explain the following concepts:

 The purpose of a patient record

 The purpose of a guarantor account

 The purpose of a coverage record

 The purpose of a hospital account

 The relationship between a hospital account, guarantor account, patient record, and

coverage record