EPIC CERTIFICATION EXAM 2026
COMPREHENSIVE STUDY GUIDE COMPLETE
ANSWERS
◉ Your reimbursement contract build calculates you will be able to
receive $64.00 from the payer and patient. This is the _____________.
Choose only one answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount. Answer: B. Expected Reimbursement Amount
◉ The payer's calculation matches your contract and the payer agrees
that you should be able to collect $64. This is the ________. Choose
only one answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount. Answer: A. Allowed Amount
,◉ 4. The difference between the price of the charge and what the payer
agrees that you should be able to collect is $13.00. This is the
________________. Choose only ONE answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount. Answer: D. Not Allowed Amount
◉ Billed amount. Answer: total amount charged for a service
The price of a charge sent out on the claim to the payer
◉ Expected reimbursement amount. Answer: The amount built in your
reimbursement contract that you expect to collect.
◉ Allowed amount. Answer: The maximum amount an insurer will pay
for any given service.
Actual collectable amount on the EOB from a payer.
◉ Not allowed amount. Answer: difference between billed amount and
allowed amount
,The difference between the allowed amount and the billed amount that is
written off.
◉ Purpose of reimbursement contracts. Answer: Reimbursement
contracts allow you to compare the allowed amount you expect to
receive from a payer. to what you actually receive for every charge
associated with that particular payer. You can easily track underpayment
and undercharging scenarios when reimbursement contracts are built in
Epic.
Reimbursement contracts are only used for calculating reimbursement or
allowed amounts and do NOT affect the price of a charge. Contracts can
be configured to perform automatic write‐offs, or to track and analyze
payer responses against what you expect to receive.
◉ Benefits/challenges of reimbursement contracts. Answer: Pros:
Increased reporting capabilities
Helpful in negotiations with payers
Auto‐populating allowed amounts in Payment Posting
Ability to route underpayments to work queues for follow‐up
Cons:
Requires time commitment to set up and maintain
, Increased usage = increased maintenance ﴾the more you build, the more
you have to maintain﴿
Information is only as accurate as you make it
◉ End‐user workflows affected by reimbursement contracts
EXAMPLE: Watch as your trainer enters a 99213 for a Benjamin
performed by Rob Marino explore contract details in Hyperspace..
Answer: Reimbursement contract information can appear to end users in
multiple places in Hyperspace. Charge entry staff can see when a
contract is associated with a charge session. The same options are
available in charge review. In a charge session, the user can also see
information about allowed amount for a specific charge by selecting the
appropriate charge, then clicking Show Benefit Summary.
Once the charge is posted to the guarantor account, you can then view
the expected reimbursement amount of the charge in PB Transaction
Inquiry.
When a contracted payer pays a claim, the expected reimbursement
amount from the reimbursement contract automatically populates the
Allowed field for manual payment posting. If there is a discrepancy
between the contract calculation done in Epic and the allowed amount
remitted by the payer, the discrepancy is automatically flagged and can
be routed to a Follow‐up work queue or worked from an underpayment
report.
COMPREHENSIVE STUDY GUIDE COMPLETE
ANSWERS
◉ Your reimbursement contract build calculates you will be able to
receive $64.00 from the payer and patient. This is the _____________.
Choose only one answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount. Answer: B. Expected Reimbursement Amount
◉ The payer's calculation matches your contract and the payer agrees
that you should be able to collect $64. This is the ________. Choose
only one answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount. Answer: A. Allowed Amount
,◉ 4. The difference between the price of the charge and what the payer
agrees that you should be able to collect is $13.00. This is the
________________. Choose only ONE answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount. Answer: D. Not Allowed Amount
◉ Billed amount. Answer: total amount charged for a service
The price of a charge sent out on the claim to the payer
◉ Expected reimbursement amount. Answer: The amount built in your
reimbursement contract that you expect to collect.
◉ Allowed amount. Answer: The maximum amount an insurer will pay
for any given service.
Actual collectable amount on the EOB from a payer.
◉ Not allowed amount. Answer: difference between billed amount and
allowed amount
,The difference between the allowed amount and the billed amount that is
written off.
◉ Purpose of reimbursement contracts. Answer: Reimbursement
contracts allow you to compare the allowed amount you expect to
receive from a payer. to what you actually receive for every charge
associated with that particular payer. You can easily track underpayment
and undercharging scenarios when reimbursement contracts are built in
Epic.
Reimbursement contracts are only used for calculating reimbursement or
allowed amounts and do NOT affect the price of a charge. Contracts can
be configured to perform automatic write‐offs, or to track and analyze
payer responses against what you expect to receive.
◉ Benefits/challenges of reimbursement contracts. Answer: Pros:
Increased reporting capabilities
Helpful in negotiations with payers
Auto‐populating allowed amounts in Payment Posting
Ability to route underpayments to work queues for follow‐up
Cons:
Requires time commitment to set up and maintain
, Increased usage = increased maintenance ﴾the more you build, the more
you have to maintain﴿
Information is only as accurate as you make it
◉ End‐user workflows affected by reimbursement contracts
EXAMPLE: Watch as your trainer enters a 99213 for a Benjamin
performed by Rob Marino explore contract details in Hyperspace..
Answer: Reimbursement contract information can appear to end users in
multiple places in Hyperspace. Charge entry staff can see when a
contract is associated with a charge session. The same options are
available in charge review. In a charge session, the user can also see
information about allowed amount for a specific charge by selecting the
appropriate charge, then clicking Show Benefit Summary.
Once the charge is posted to the guarantor account, you can then view
the expected reimbursement amount of the charge in PB Transaction
Inquiry.
When a contracted payer pays a claim, the expected reimbursement
amount from the reimbursement contract automatically populates the
Allowed field for manual payment posting. If there is a discrepancy
between the contract calculation done in Epic and the allowed amount
remitted by the payer, the discrepancy is automatically flagged and can
be routed to a Follow‐up work queue or worked from an underpayment
report.
