EPIC COG230 REVENUE DATA MODEL
QUESTIONS & ANSWERS|| LATEST
UPDATE 2026|| RATED A+
Accounts Receivable - ANSWEROutstanding money we expect to receive in the future
Three Transaction Types: - ANSWERCharges
Payments
Adjustments
Charges occur as a result of: - ANSWERPerforming services
Payments are a result of: - ANSWERReceiving money
What are adjustments? - ANSWERAnything that changes AR (Credit Adjustments or
Debit Adjustments)
An example of a credit adjustment is: - ANSWERContractual write-offs
An example of a debit adjustment is: - ANSWERA refund
Debits _______ AR - ANSWERIncrease (Charges and Debit Adjustments)
Credits ________ AR - ANSWERDecrease (Payments and Credit Adjustments)
What is the function of a Hospital Account (HAR)? - ANSWERCollects transactions
related to an encounter and centralizes encounters, transactions, insurance, etc.
Insurance coverage, is a unique combination of what 3 things? - ANSWERPayer
Plan
Subscriber
What is an insurance payer? - ANSWERThe insurance company
What is an insurance plan? - ANSWERThe set of benefits a patient receives
What is an insurance subsriber? - ANSWERThe policy holder
What is a guarantor? - ANSWERThe person ultimately responsible for payment. This
could be the patient or someone else (ie. the subscriber)
,Who is the insurance member? - ANSWERThe member is who the insurance coverage
is for. For example, if a subscriber has children. The children are members of the
subscriber's plan.
If a patient has multiple coverages, the order in which they are billed is called the: -
ANSWERFiling Order
True or False
Every Hospital Account must be connected to a guarantor - ANSWERTrue
True or False
Every PB Transaction must be connected to a guarantor - ANSWERTrue
What are the two hospital applications used to track billing? - ANSWER1. Resolute
Professional Billing
2. Resolute Hospital Billing
What services do Professional Billing cover? - ANSWERServices performed by
clinicians in inpatient or outpatient settings
What services do Hospital Billing cover? - ANSWERServices and supplies related to
hospital encounters, including: medications, lab charges, imaging, room and bed
charges and more.
True or False
Hospital Billing doesn't need to achieve the level of granularity that Professional Billing
needs and does not need to match every payment to each charge - ANSWERTrue
PB transactions are stored in the ___ master file - ANSWERETR
HB transactions are stored in the ___ master file - ANSWERHTR
Which system did EPIC have early on in its' development, Professional or Hospital
Billing? - ANSWERProfessional Billing
What is the purpose of a Single Billing Office (SBO)? - ANSWERSBO is a billing mode
that combines HB and PB balances into a single guarantor statement. Thus, creating
simpler statements for easier management for guarantors.
Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Which transactions occurred? - ANSWEROne charge, two payments, one credit
adjustment
, Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Which billing system is this likely being tracked in? - ANSWERProfessional
Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Who is the guarantor? - ANSWERLeslie
Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Who is likely the subscriber of the coverage? - ANSWERLeslie
Which tables contain guarantor information in Caboodle and in Clarity? -
ANSWERClarity: ACCOUNT
Caboodle: GuarantorDim
What are the four separate guarantor balances? - ANSWERTotal Balance
Insurance balance
Self-Pay Balance
Bad Debt
In the guarantor table (ACCOUNT), columns TOTAL_BALANCE,
INSURANCE_BALANCE, PATIENT_BALANCE and BAD_DEBT_BALANCE all refer to
which billing system (Hospital v. Professional)? - ANSWERProfessional. This is due to
professional billing originally being the only billing type tracked
What are the main Clarity and Caboodle tables for Coverages? - ANSWERClarity:
COVERAGE and V_COVERAGE_PAYOR_PLAN
Caboodle: CoverageDim
What is a claim? - ANSWERA bill for payment sent to insurance for the services
provided to the patient
QUESTIONS & ANSWERS|| LATEST
UPDATE 2026|| RATED A+
Accounts Receivable - ANSWEROutstanding money we expect to receive in the future
Three Transaction Types: - ANSWERCharges
Payments
Adjustments
Charges occur as a result of: - ANSWERPerforming services
Payments are a result of: - ANSWERReceiving money
What are adjustments? - ANSWERAnything that changes AR (Credit Adjustments or
Debit Adjustments)
An example of a credit adjustment is: - ANSWERContractual write-offs
An example of a debit adjustment is: - ANSWERA refund
Debits _______ AR - ANSWERIncrease (Charges and Debit Adjustments)
Credits ________ AR - ANSWERDecrease (Payments and Credit Adjustments)
What is the function of a Hospital Account (HAR)? - ANSWERCollects transactions
related to an encounter and centralizes encounters, transactions, insurance, etc.
Insurance coverage, is a unique combination of what 3 things? - ANSWERPayer
Plan
Subscriber
What is an insurance payer? - ANSWERThe insurance company
What is an insurance plan? - ANSWERThe set of benefits a patient receives
What is an insurance subsriber? - ANSWERThe policy holder
What is a guarantor? - ANSWERThe person ultimately responsible for payment. This
could be the patient or someone else (ie. the subscriber)
,Who is the insurance member? - ANSWERThe member is who the insurance coverage
is for. For example, if a subscriber has children. The children are members of the
subscriber's plan.
If a patient has multiple coverages, the order in which they are billed is called the: -
ANSWERFiling Order
True or False
Every Hospital Account must be connected to a guarantor - ANSWERTrue
True or False
Every PB Transaction must be connected to a guarantor - ANSWERTrue
What are the two hospital applications used to track billing? - ANSWER1. Resolute
Professional Billing
2. Resolute Hospital Billing
What services do Professional Billing cover? - ANSWERServices performed by
clinicians in inpatient or outpatient settings
What services do Hospital Billing cover? - ANSWERServices and supplies related to
hospital encounters, including: medications, lab charges, imaging, room and bed
charges and more.
True or False
Hospital Billing doesn't need to achieve the level of granularity that Professional Billing
needs and does not need to match every payment to each charge - ANSWERTrue
PB transactions are stored in the ___ master file - ANSWERETR
HB transactions are stored in the ___ master file - ANSWERHTR
Which system did EPIC have early on in its' development, Professional or Hospital
Billing? - ANSWERProfessional Billing
What is the purpose of a Single Billing Office (SBO)? - ANSWERSBO is a billing mode
that combines HB and PB balances into a single guarantor statement. Thus, creating
simpler statements for easier management for guarantors.
Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Which transactions occurred? - ANSWEROne charge, two payments, one credit
adjustment
, Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Which billing system is this likely being tracked in? - ANSWERProfessional
Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Who is the guarantor? - ANSWERLeslie
Diakeishaye goes to the doctor for a physical. This generates one charge for $50. A
claim is sent to Aetna, which sends a check for $35, saying there is a $5 patient portion.
$10 gets written off, and the rest is sent to Diakeishaye's mother, Leslie, who sends in a
check two days later
Who is likely the subscriber of the coverage? - ANSWERLeslie
Which tables contain guarantor information in Caboodle and in Clarity? -
ANSWERClarity: ACCOUNT
Caboodle: GuarantorDim
What are the four separate guarantor balances? - ANSWERTotal Balance
Insurance balance
Self-Pay Balance
Bad Debt
In the guarantor table (ACCOUNT), columns TOTAL_BALANCE,
INSURANCE_BALANCE, PATIENT_BALANCE and BAD_DEBT_BALANCE all refer to
which billing system (Hospital v. Professional)? - ANSWERProfessional. This is due to
professional billing originally being the only billing type tracked
What are the main Clarity and Caboodle tables for Coverages? - ANSWERClarity:
COVERAGE and V_COVERAGE_PAYOR_PLAN
Caboodle: CoverageDim
What is a claim? - ANSWERA bill for payment sent to insurance for the services
provided to the patient
