RPB390 EPIC CERTIFICATION QUESTIONS &
ANSWERS
A charge posts with a price of $77.00, this is the _______. Choose only one answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount - Answers - C. Billed Amount
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 - Answers - 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 - Answers - 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 - Answers - D. Not Allowed Amount
Billed amount - Answers - total amount charged for a service
The price of a charge sent out on the claim to the payer
Expected reimbursement amount - Answers - The amount built in your reimbursement
contract that you expect to collect.
Allowed amount - Answers - The maximum amount an insurer will pay for any given
service.
,Actual collectable amount on the EOB from a payer.
Not allowed amount - Answers - 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 - Answers - 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 - Answers - 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. - Answers - 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.
In which environment do end users perform their daily workflows? Choose ONLY one:
A. POC
B. TST
C. SUP
D. PRD - Answers - D. PRD
True or false: All initial build is typically completed in the TST environment. - Answers -
False.
POC = Proof of Concept
What records created from Registration are needed to test Reimbursement contract
build? Choose ALL that apply.
A. Patient
B. Guarantor Account
C. Coverage - Answers - All of the above
A. Patient
B. Guarantor Account
C. Coverage
Environment - Answers - Creating new build for your organization requires a change
control process that may involve numerous stages of testing. Understanding the basics
of the environments used for build will help guide some of the build processes to follow.
The backbone of your environment strategy consists of a linear series of environments
in support of your production ﴾PRD﴿ environment. Build updates move through the
environments using Data Courier.
POC Environment - Answers - Proof of Concept
This is the environment that you use to complete your initial build by creating or editing
records. Build from this environment is sent to TST using the Data Courier tool.
TST Environment - Answers - Test
This environment is configured to closely simulate PRD. It is used to test build before
sending it to PRD
PRD Environment - Answers - Production
This is the final, live environment where all end users do their work.
ANSWERS
A charge posts with a price of $77.00, this is the _______. Choose only one answer.
A. Allowed Amount
B. Expected Reimbursement Amount
C. Billed Amount
D. Not Allowed Amount - Answers - C. Billed Amount
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 - Answers - 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 - Answers - 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 - Answers - D. Not Allowed Amount
Billed amount - Answers - total amount charged for a service
The price of a charge sent out on the claim to the payer
Expected reimbursement amount - Answers - The amount built in your reimbursement
contract that you expect to collect.
Allowed amount - Answers - The maximum amount an insurer will pay for any given
service.
,Actual collectable amount on the EOB from a payer.
Not allowed amount - Answers - 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 - Answers - 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 - Answers - 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. - Answers - 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.
In which environment do end users perform their daily workflows? Choose ONLY one:
A. POC
B. TST
C. SUP
D. PRD - Answers - D. PRD
True or false: All initial build is typically completed in the TST environment. - Answers -
False.
POC = Proof of Concept
What records created from Registration are needed to test Reimbursement contract
build? Choose ALL that apply.
A. Patient
B. Guarantor Account
C. Coverage - Answers - All of the above
A. Patient
B. Guarantor Account
C. Coverage
Environment - Answers - Creating new build for your organization requires a change
control process that may involve numerous stages of testing. Understanding the basics
of the environments used for build will help guide some of the build processes to follow.
The backbone of your environment strategy consists of a linear series of environments
in support of your production ﴾PRD﴿ environment. Build updates move through the
environments using Data Courier.
POC Environment - Answers - Proof of Concept
This is the environment that you use to complete your initial build by creating or editing
records. Build from this environment is sent to TST using the Data Courier tool.
TST Environment - Answers - Test
This environment is configured to closely simulate PRD. It is used to test build before
sending it to PRD
PRD Environment - Answers - Production
This is the final, live environment where all end users do their work.
