RHB390 QUESTIONS & ANSWERS
Open HAR Status - term - Answers - Patient is pre-admitted or admtted
DNB (Discharged Not Billed) - Answers - When coding is performed
Billed - Answers - HAR has successfully passed Initiate Billing and the balance on the
HAR has been assigned
Closed HAR - Answers - HAR has no remaining balance
How are buckets used in the rev - Answers - They assign and track financial liability of
an HB HAR
Hospital Account (HAR) - Answers - HARs store all HB charges, payments, and
adjustments for an encounter
Min Days - Answers - Minimum number of days between discharge and attempt to bill
the HB HAR
Initiate billing - Answers - The moment billing begins on the HAR
Allowed Amount - Answers - maximum reimbursement calculated and sent by the payer
expected amount - Answers - maximum reimbursement as calculated by the contract
Billed amount - Answers - total of charges sent to payer
Paid amount - Answers - total amount paid by payer for claim
Posted write-off - Answers - contractual adjustments
NRP - Answers - next responsible party
Payment Mechanism - Answers - defines how to calculate the expected reimbursement
for the associated contract line
Patient record - Answers - holds demographics and medical information
guarantor account - Answers - the entity that will be legally financially responsible for
any remaining balance not covered by insurance
coverage account - Answers - stores insurance information, a unique combination
Payer + Plan + Subscriber
, What part of a contract line defines that service - Answers - Component or Component
Group
True or false When building s contract line, you can only look at one type of criteria;
meaning you cannot look for both Rev codes and DRGs simultaneously - Answers -
False, component groups allow you to look for more than one piece of criterial on a
claim line
Which step creates the insurance bucket from which we can demand a claim? -
Answers - Initiate billing
True or false: when ordering contract lines, the more specific lines should go first -
Answers - True, you should generally order more specific contract lines above more
general lines, and should be aware of how the contract will search the claim
True or false: Contacts are used to track changes to a contract over time - Answers -
True: contacts are used to track changes to contract over time
True or false: two contracts at your organization can have the same eligibility
requirements on the "Applies To" tab - Answers - false "Applies to" tab must be unique
True or false: it is possible for a contract to continue pricing a claim after a stopping
condition has been triggered - Answers - false: stopping conditions define evaluation
parameters
A negotiated contract term for your organization defines a service with both a revenue
code and a DRG code. What do you need to build to define the service for this contract
line? - Answers - a component and component group
True or false: in general, outpatient contract lines should be ordered below inpatient
contract lines - Answers - True, inpatient contract lines before outpatient lines, as
inpatient charges are reimbursed at a higher rate.
Your contract with Rocky's Insurance Co. specifies that if an inpatient bed charge
revenue code is reimbursed at a per diem rate, no other impatient charges should be
reimbursed. What must you do to build this contract? - Answers - Add a stopping
condition to the last inpatient bed charge per diem contract line
It is the end of the fiscal year, any your organization has renegotiated your contract with
New Horizons Insurance. You already have a contract built for New Horizons from the
past year, and four of the 29 contract terms are changing for the new fiscal year. What
is the most efficient way to build the updated New Horizons contract? - Answers -
Create a new contact for the contract and update the terms for New Horizon
Open HAR Status - term - Answers - Patient is pre-admitted or admtted
DNB (Discharged Not Billed) - Answers - When coding is performed
Billed - Answers - HAR has successfully passed Initiate Billing and the balance on the
HAR has been assigned
Closed HAR - Answers - HAR has no remaining balance
How are buckets used in the rev - Answers - They assign and track financial liability of
an HB HAR
Hospital Account (HAR) - Answers - HARs store all HB charges, payments, and
adjustments for an encounter
Min Days - Answers - Minimum number of days between discharge and attempt to bill
the HB HAR
Initiate billing - Answers - The moment billing begins on the HAR
Allowed Amount - Answers - maximum reimbursement calculated and sent by the payer
expected amount - Answers - maximum reimbursement as calculated by the contract
Billed amount - Answers - total of charges sent to payer
Paid amount - Answers - total amount paid by payer for claim
Posted write-off - Answers - contractual adjustments
NRP - Answers - next responsible party
Payment Mechanism - Answers - defines how to calculate the expected reimbursement
for the associated contract line
Patient record - Answers - holds demographics and medical information
guarantor account - Answers - the entity that will be legally financially responsible for
any remaining balance not covered by insurance
coverage account - Answers - stores insurance information, a unique combination
Payer + Plan + Subscriber
, What part of a contract line defines that service - Answers - Component or Component
Group
True or false When building s contract line, you can only look at one type of criteria;
meaning you cannot look for both Rev codes and DRGs simultaneously - Answers -
False, component groups allow you to look for more than one piece of criterial on a
claim line
Which step creates the insurance bucket from which we can demand a claim? -
Answers - Initiate billing
True or false: when ordering contract lines, the more specific lines should go first -
Answers - True, you should generally order more specific contract lines above more
general lines, and should be aware of how the contract will search the claim
True or false: Contacts are used to track changes to a contract over time - Answers -
True: contacts are used to track changes to contract over time
True or false: two contracts at your organization can have the same eligibility
requirements on the "Applies To" tab - Answers - false "Applies to" tab must be unique
True or false: it is possible for a contract to continue pricing a claim after a stopping
condition has been triggered - Answers - false: stopping conditions define evaluation
parameters
A negotiated contract term for your organization defines a service with both a revenue
code and a DRG code. What do you need to build to define the service for this contract
line? - Answers - a component and component group
True or false: in general, outpatient contract lines should be ordered below inpatient
contract lines - Answers - True, inpatient contract lines before outpatient lines, as
inpatient charges are reimbursed at a higher rate.
Your contract with Rocky's Insurance Co. specifies that if an inpatient bed charge
revenue code is reimbursed at a per diem rate, no other impatient charges should be
reimbursed. What must you do to build this contract? - Answers - Add a stopping
condition to the last inpatient bed charge per diem contract line
It is the end of the fiscal year, any your organization has renegotiated your contract with
New Horizons Insurance. You already have a contract built for New Horizons from the
past year, and four of the 29 contract terms are changing for the new fiscal year. What
is the most efficient way to build the updated New Horizons contract? - Answers -
Create a new contact for the contract and update the terms for New Horizon
