RPB390 EPIC CERTIFICATION EXAM QUESTIONS WITH
CORRECT RATIONALES
A ccharge cposts cwith ca cprice cof c$77.00, cthis cis cthe c_______. cChoose conly cone canswer.
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount c
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔C. cBilled cAmount
Your creimbursement ccontract cbuild ccalculates cyou cwill cbe cable cto creceive c$64.00 cfrom cthe cpayer cand cpatient. cThis cis cthe
c_____________. cChoose conly cone canswer.
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount c
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔B. cExpected cReimbursement cAmount
The cpayer's ccalculation cmatches cyour ccontract cand cthe cpayer cagrees cthat cyou cshould cbe cable cto ccollect c$64. cThis cis cthe
c________. cChoose conly cone canswer.
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount c
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔A. cAllowed cAmount
4. cThe cdifference cbetween cthe cprice cof cthe ccharge cand cwhat cthe cpayer cagrees cthat cyou cshould cbe cable cto ccollect cis
c$13.00. cThis cis cthe c________________. cChoose conly cONE canswer. c
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔D. cNot cAllowed cAmount
Billed camount c- cCORRECT cANS✔✔total camount ccharged cfor ca cservice
The cprice cof ca ccharge csent cout con cthe cclaim cto cthe cpayer
Expected creimbursement camount c- cCORRECT cANS✔✔The camount cbuilt cin cyour creimbursement ccontract cthat cyou cexpect cto
ccollect.
Allowed camount c- cCORRECT cANS✔✔The cmaximum camount can cinsurer cwill cpay cfor cany cgiven cservice.
Actual ccollectable camount con cthe cEOB cfrom ca cpayer.
Not callowed camount c- cCORRECT cANS✔✔difference cbetween cbilled camount cand callowed camount
The cdifference cbetween cthe callowed camount cand cthe cbilled camount cthat cis cwritten coff.
Purpose cof creimbursement ccontracts c- cCORRECT cANS✔✔Reimbursement ccontracts callow cyou cto ccompare cthe callowed
camount cyou cexpect cto creceive cfrom ca cpayer. cto cwhat cyou cactually creceive cfor cevery ccharge cassociated cwith cthat cparticular
cpayer. cYou ccan ceasily ctrack cunderpayment cand cundercharging cscenarios cwhen creimbursement ccontracts care cbuilt cin cEpic.
, Reimbursement ccontracts care conly cused cfor ccalculating creimbursement cor callowed camounts cand cdo cNOT caffect cthe cprice cof
ca ccharge. cContracts ccan cbe cconfigured cto cperform cautomatic cwrite‐offs, cor cto ctrack cand canalyze cpayer cresponses cagainst
cwhat cyou cexpect cto creceive.
Benefits/challenges cof creimbursement ccontracts c- cCORRECT cANS✔✔Pros: c
Increased creporting ccapabilities c
Helpful cin cnegotiations cwith cpayers c
Auto‐populating callowed camounts cin cPayment cPosting c
Ability cto croute cunderpayments cto cwork cqueues cfor cfollow‐up
Cons:
Requires ctime ccommitment cto cset cup cand cmaintain c
Increased cusage c= cincreased cmaintenance c﴾the cmore cyou cbuild, cthe cmore cyou chave cto cmaintain﴿ c
Information cis conly cas caccurate cas cyou cmake cit
End‐user cworkflows caffected cby creimbursement ccontracts
EXAMPLE: cWatch cas cyour ctrainer centers ca c99213 cfor ca cBenjamin cperformed cby cRob cMarino cexplore ccontract cdetails cin
cHyperspace. c- cCORRECT cANS✔✔Reimbursement ccontract cinformation ccan cappear cto cend cusers cin cmultiple cplaces cin
cHyperspace. cCharge centry cstaff ccan csee cwhen ca ccontract cis cassociated cwith ca ccharge csession. cThe csame coptions care
cavailable cin ccharge creview. cIn ca ccharge csession, cthe cuser ccan calso csee cinformation cabout callowed camount cfor ca cspecific
ccharge cby cselecting cthe cappropriate ccharge, cthen cclicking cShow cBenefit cSummary.
Once cthe ccharge cis cposted cto cthe cguarantor caccount, cyou ccan cthen cview cthe cexpected creimbursement camount cof cthe
ccharge cin cPB cTransaction cInquiry.
When ca ccontracted cpayer cpays ca cclaim, cthe cexpected creimbursement camount cfrom cthe creimbursement ccontract
cautomatically cpopulates cthe cAllowed cfield cfor cmanual cpayment cposting. cIf cthere cis ca cdiscrepancy cbetween cthe ccontract
ccalculation cdone cin cEpic cand cthe callowed camount cremitted cby cthe cpayer, cthe cdiscrepancy cis cautomatically cflagged cand ccan
cbe crouted cto ca cFollow‐up cwork cqueue cor cworked cfrom can cunderpayment creport.
In cwhich cenvironment cdo cend cusers cperform ctheir cdaily cworkflows? cChoose cONLY cone: c
A. cPOC c
B. cTST c
C. cSUP c
D. cPRD c- cCORRECT cANS✔✔D. cPRD
True cor cfalse: cAll cinitial cbuild cis ctypically ccompleted cin cthe cTST cenvironment. c- cCORRECT cANS✔✔False.
POC c= cProof cof cConcept
What crecords ccreated cfrom cRegistration care cneeded cto ctest cReimbursement ccontract cbuild? cChoose cALL cthat capply. c
A. cPatient c
B. cGuarantor cAccount c
C. cCoverage c- cCORRECT cANS✔✔All cof cthe cabove
A. cPatient c
B. cGuarantor cAccount c
C. cCoverage
Environment c- cCORRECT cANS✔✔Creating cnew cbuild cfor cyour corganization crequires ca cchange ccontrol cprocess cthat cmay
cinvolve cnumerous cstages cof ctesting. cUnderstanding cthe cbasics cof cthe cenvironments cused cfor cbuild cwill chelp cguide csome cof
cthe cbuild cprocesses cto cfollow.
The cbackbone cof cyour cenvironment cstrategy cconsists cof ca clinear cseries cof cenvironments cin csupport cof cyour cproduction
c﴾PRD﴿ cenvironment. cBuild cupdates cmove cthrough cthe cenvironments cusing cData cCourier.
POC cEnvironment c- cCORRECT cANS✔✔Proof cof cConcept
This cis cthe cenvironment cthat cyou cuse cto ccomplete cyour cinitial cbuild cby ccreating cor cediting crecords. cBuild cfrom cthis
cenvironment cis csent cto cTST cusing cthe cData cCourier ctool.
TST cEnvironment c- cCORRECT cANS✔✔Test
This cenvironment cis cconfigured cto cclosely csimulate cPRD. cIt cis cused cto ctest cbuild cbefore csending cit cto cPRD
PRD cEnvironment c- cCORRECT cANS✔✔Production
This cis cthe cfinal, clive cenvironment cwhere call cend cusers cdo ctheir cwork.
SUP cEnvironment c- cCORRECT cANS✔✔Support
This cis caccessed cfor ctroubleshooting cproduction cissues. cIt's cproduced cas ca cnightly ccopy cof cPRD. cSUP cis calso cused cto ctest
cbuild con creal cpatient cdata cbefore cit's cmigrated cto cPRD.
CORRECT RATIONALES
A ccharge cposts cwith ca cprice cof c$77.00, cthis cis cthe c_______. cChoose conly cone canswer.
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount c
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔C. cBilled cAmount
Your creimbursement ccontract cbuild ccalculates cyou cwill cbe cable cto creceive c$64.00 cfrom cthe cpayer cand cpatient. cThis cis cthe
c_____________. cChoose conly cone canswer.
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount c
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔B. cExpected cReimbursement cAmount
The cpayer's ccalculation cmatches cyour ccontract cand cthe cpayer cagrees cthat cyou cshould cbe cable cto ccollect c$64. cThis cis cthe
c________. cChoose conly cone canswer.
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount c
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔A. cAllowed cAmount
4. cThe cdifference cbetween cthe cprice cof cthe ccharge cand cwhat cthe cpayer cagrees cthat cyou cshould cbe cable cto ccollect cis
c$13.00. cThis cis cthe c________________. cChoose conly cONE canswer. c
A. cAllowed cAmount c
B. cExpected cReimbursement cAmount
C. cBilled cAmount c
D. cNot cAllowed cAmount c- cCORRECT cANS✔✔D. cNot cAllowed cAmount
Billed camount c- cCORRECT cANS✔✔total camount ccharged cfor ca cservice
The cprice cof ca ccharge csent cout con cthe cclaim cto cthe cpayer
Expected creimbursement camount c- cCORRECT cANS✔✔The camount cbuilt cin cyour creimbursement ccontract cthat cyou cexpect cto
ccollect.
Allowed camount c- cCORRECT cANS✔✔The cmaximum camount can cinsurer cwill cpay cfor cany cgiven cservice.
Actual ccollectable camount con cthe cEOB cfrom ca cpayer.
Not callowed camount c- cCORRECT cANS✔✔difference cbetween cbilled camount cand callowed camount
The cdifference cbetween cthe callowed camount cand cthe cbilled camount cthat cis cwritten coff.
Purpose cof creimbursement ccontracts c- cCORRECT cANS✔✔Reimbursement ccontracts callow cyou cto ccompare cthe callowed
camount cyou cexpect cto creceive cfrom ca cpayer. cto cwhat cyou cactually creceive cfor cevery ccharge cassociated cwith cthat cparticular
cpayer. cYou ccan ceasily ctrack cunderpayment cand cundercharging cscenarios cwhen creimbursement ccontracts care cbuilt cin cEpic.
, Reimbursement ccontracts care conly cused cfor ccalculating creimbursement cor callowed camounts cand cdo cNOT caffect cthe cprice cof
ca ccharge. cContracts ccan cbe cconfigured cto cperform cautomatic cwrite‐offs, cor cto ctrack cand canalyze cpayer cresponses cagainst
cwhat cyou cexpect cto creceive.
Benefits/challenges cof creimbursement ccontracts c- cCORRECT cANS✔✔Pros: c
Increased creporting ccapabilities c
Helpful cin cnegotiations cwith cpayers c
Auto‐populating callowed camounts cin cPayment cPosting c
Ability cto croute cunderpayments cto cwork cqueues cfor cfollow‐up
Cons:
Requires ctime ccommitment cto cset cup cand cmaintain c
Increased cusage c= cincreased cmaintenance c﴾the cmore cyou cbuild, cthe cmore cyou chave cto cmaintain﴿ c
Information cis conly cas caccurate cas cyou cmake cit
End‐user cworkflows caffected cby creimbursement ccontracts
EXAMPLE: cWatch cas cyour ctrainer centers ca c99213 cfor ca cBenjamin cperformed cby cRob cMarino cexplore ccontract cdetails cin
cHyperspace. c- cCORRECT cANS✔✔Reimbursement ccontract cinformation ccan cappear cto cend cusers cin cmultiple cplaces cin
cHyperspace. cCharge centry cstaff ccan csee cwhen ca ccontract cis cassociated cwith ca ccharge csession. cThe csame coptions care
cavailable cin ccharge creview. cIn ca ccharge csession, cthe cuser ccan calso csee cinformation cabout callowed camount cfor ca cspecific
ccharge cby cselecting cthe cappropriate ccharge, cthen cclicking cShow cBenefit cSummary.
Once cthe ccharge cis cposted cto cthe cguarantor caccount, cyou ccan cthen cview cthe cexpected creimbursement camount cof cthe
ccharge cin cPB cTransaction cInquiry.
When ca ccontracted cpayer cpays ca cclaim, cthe cexpected creimbursement camount cfrom cthe creimbursement ccontract
cautomatically cpopulates cthe cAllowed cfield cfor cmanual cpayment cposting. cIf cthere cis ca cdiscrepancy cbetween cthe ccontract
ccalculation cdone cin cEpic cand cthe callowed camount cremitted cby cthe cpayer, cthe cdiscrepancy cis cautomatically cflagged cand ccan
cbe crouted cto ca cFollow‐up cwork cqueue cor cworked cfrom can cunderpayment creport.
In cwhich cenvironment cdo cend cusers cperform ctheir cdaily cworkflows? cChoose cONLY cone: c
A. cPOC c
B. cTST c
C. cSUP c
D. cPRD c- cCORRECT cANS✔✔D. cPRD
True cor cfalse: cAll cinitial cbuild cis ctypically ccompleted cin cthe cTST cenvironment. c- cCORRECT cANS✔✔False.
POC c= cProof cof cConcept
What crecords ccreated cfrom cRegistration care cneeded cto ctest cReimbursement ccontract cbuild? cChoose cALL cthat capply. c
A. cPatient c
B. cGuarantor cAccount c
C. cCoverage c- cCORRECT cANS✔✔All cof cthe cabove
A. cPatient c
B. cGuarantor cAccount c
C. cCoverage
Environment c- cCORRECT cANS✔✔Creating cnew cbuild cfor cyour corganization crequires ca cchange ccontrol cprocess cthat cmay
cinvolve cnumerous cstages cof ctesting. cUnderstanding cthe cbasics cof cthe cenvironments cused cfor cbuild cwill chelp cguide csome cof
cthe cbuild cprocesses cto cfollow.
The cbackbone cof cyour cenvironment cstrategy cconsists cof ca clinear cseries cof cenvironments cin csupport cof cyour cproduction
c﴾PRD﴿ cenvironment. cBuild cupdates cmove cthrough cthe cenvironments cusing cData cCourier.
POC cEnvironment c- cCORRECT cANS✔✔Proof cof cConcept
This cis cthe cenvironment cthat cyou cuse cto ccomplete cyour cinitial cbuild cby ccreating cor cediting crecords. cBuild cfrom cthis
cenvironment cis csent cto cTST cusing cthe cData cCourier ctool.
TST cEnvironment c- cCORRECT cANS✔✔Test
This cenvironment cis cconfigured cto cclosely csimulate cPRD. cIt cis cused cto ctest cbuild cbefore csending cit cto cPRD
PRD cEnvironment c- cCORRECT cANS✔✔Production
This cis cthe cfinal, clive cenvironment cwhere call cend cusers cdo ctheir cwork.
SUP cEnvironment c- cCORRECT cANS✔✔Support
This cis caccessed cfor ctroubleshooting cproduction cissues. cIt's cproduced cas ca cnightly ccopy cof cPRD. cSUP cis calso cused cto ctest
cbuild con creal cpatient cdata cbefore cit's cmigrated cto cPRD.
