Test Bank for RHB303 - Questions with Verified Answers Latest 2025
Hospital Systems Definition (HSD) - Answers Also called the Hospital Billing Profile, the HSD is a record
that contains configuration settings for Hospital Billing and applications that use the Hospital Billing
framework (HB-specific). A single HSD record exists at the facility level and is automatically created and
connected to the facility record.
Enterprise Billing Profile (SSD) - Answers Contains configuration settings that apply to enterprise
features in the system. It is only service area-level, but contains settings that are shared between HB and
PB.
Rule of Specifity - Answers The system will use the most specific setting available. If a setting is not found
at the most specific level, it will continue looking up until a setting is found.
Coverage Manager - Answers Determines the actions that can take place on HB HARs due to late
coverage changes. Can only be set at the Facility or Service Area-Level HSDs.
Restrict Coverages to Guarantor field - Answers A setting in Coverage Manager that makes sure actions
are performed only if the coverage is on the guarantor account associated with the hospital account. If
set to No, Coverage Manager also will review late coverage changes for coverages that are connected to
the patient record as well.
What status must a HAR have in order to make coverage changes? - Answers Open or DNB. If a coverage
change is on a patient with a HAR with a Billed status, then either a stop bill should be placed on the
HAR, or the HAR will be worked from a denials workqueue once the payer response is received.
Tables with a capital T - Answers These tables evaluate from the top down. This means that any
exceptions to the default need to be higher in the table than the default option.
What are the Hospital Billing Profiles and Enterprise Billing Profiles connected to in Text? - Answers They
are both connected to the service area record.
True or False: The facility EAF record and facility HSD record are automatically linked. - Answers True
True or False: A service area record and service area HSD are automatically linked. - Answers False
True or False: Professional Billing settings are configured in the HSD record. - Answers False. Hospital
Billing settings are configured in the HSD record.
Where should you set a Hospital Billing setting that you want to only apply to one service area at an
organization? - Answers At the service area-level HSD. HSD records can be attached at the Facility,
Service Area, and Location Level.
True or False: Some HSD settings are configured in Hyperspace and some are configured in Text. -
Answers True
, How is Single Billing Office enabled? - Answers It is set in the Enterprise Billing Profile and then linked to
a service area.
True or False: The order of the lines in the Coverage Manager table does not matter. - Answers False.
The table (because it is a table with a capital T) reads from the top down and the first row that matches
the scenario is the action the system will take.
True or False: Coverage Manager can add a stop bill to an HB HAR when there is a coverage change for
the guarantor connected to that account. - Answers True
Extension (LPP) - Answers Extensions contain code that the system uses to do something. Epic releases
many standard extensions that can be used to customize the system. It is generally recommended to
create a custom copy of an existing extension whenever you need to use an extension.
Rule (CER) - Answers CER rules are logical expressions that identify records that meet (or do not meet)
criteria you configure.
Where are DNB checks plugged in? - Answers They plug into the Hospital System Definitions (HSD).
When are hospital accounts evaluated against DNB checks? - Answers Initiate Billing. Additionally, some
may be configured to run at Discharge and each night through Min Days. If an account fails a DNB check,
it does not get billed and a DNB error or warning flag is applied to the account.
DNB checks - Answers Built using extension (LLP) records. Many are Epic-released records , so they can
be used as-is. If a custom DNB check is needed, then a Foundation System rule-based DNB check
extension can be duplicated to create a custom rule.
DNB check extension - Answers Can either hold the logic of the edit directly in the extension or be blank.
If the extension holds the logic, then a rule is not required unless filtering is desired. If the extension is
blank, then a rule is required.
Epic-released Extension (LPP) - Answers The Extension Record defines the problem, and is used when a
standard-released DNB check matches the edit checking needed with no modifications necessary.
Epic-released Extension (LPP) + Rule (CER) - Answers The Extension Record defines the problem, and is
used when a standard-released DNB check matches the edit checking needed but you want to limit
which hospital accounts are evaluated.
Shell Extension (custom copy or Foundation System LPP) + Rule (CER) - Answers The Rule Record (CER)
defines the problem. Used when a custom edit check is needed that is not already handled by any of the
standard or Foundation System extensions.
HSD-1 is automatically linked to the facility record, but what level hospital billing profile can be linked to
use the rule of specificity? - Answers Service area-level
Hospital Systems Definition (HSD) - Answers Also called the Hospital Billing Profile, the HSD is a record
that contains configuration settings for Hospital Billing and applications that use the Hospital Billing
framework (HB-specific). A single HSD record exists at the facility level and is automatically created and
connected to the facility record.
Enterprise Billing Profile (SSD) - Answers Contains configuration settings that apply to enterprise
features in the system. It is only service area-level, but contains settings that are shared between HB and
PB.
Rule of Specifity - Answers The system will use the most specific setting available. If a setting is not found
at the most specific level, it will continue looking up until a setting is found.
Coverage Manager - Answers Determines the actions that can take place on HB HARs due to late
coverage changes. Can only be set at the Facility or Service Area-Level HSDs.
Restrict Coverages to Guarantor field - Answers A setting in Coverage Manager that makes sure actions
are performed only if the coverage is on the guarantor account associated with the hospital account. If
set to No, Coverage Manager also will review late coverage changes for coverages that are connected to
the patient record as well.
What status must a HAR have in order to make coverage changes? - Answers Open or DNB. If a coverage
change is on a patient with a HAR with a Billed status, then either a stop bill should be placed on the
HAR, or the HAR will be worked from a denials workqueue once the payer response is received.
Tables with a capital T - Answers These tables evaluate from the top down. This means that any
exceptions to the default need to be higher in the table than the default option.
What are the Hospital Billing Profiles and Enterprise Billing Profiles connected to in Text? - Answers They
are both connected to the service area record.
True or False: The facility EAF record and facility HSD record are automatically linked. - Answers True
True or False: A service area record and service area HSD are automatically linked. - Answers False
True or False: Professional Billing settings are configured in the HSD record. - Answers False. Hospital
Billing settings are configured in the HSD record.
Where should you set a Hospital Billing setting that you want to only apply to one service area at an
organization? - Answers At the service area-level HSD. HSD records can be attached at the Facility,
Service Area, and Location Level.
True or False: Some HSD settings are configured in Hyperspace and some are configured in Text. -
Answers True
, How is Single Billing Office enabled? - Answers It is set in the Enterprise Billing Profile and then linked to
a service area.
True or False: The order of the lines in the Coverage Manager table does not matter. - Answers False.
The table (because it is a table with a capital T) reads from the top down and the first row that matches
the scenario is the action the system will take.
True or False: Coverage Manager can add a stop bill to an HB HAR when there is a coverage change for
the guarantor connected to that account. - Answers True
Extension (LPP) - Answers Extensions contain code that the system uses to do something. Epic releases
many standard extensions that can be used to customize the system. It is generally recommended to
create a custom copy of an existing extension whenever you need to use an extension.
Rule (CER) - Answers CER rules are logical expressions that identify records that meet (or do not meet)
criteria you configure.
Where are DNB checks plugged in? - Answers They plug into the Hospital System Definitions (HSD).
When are hospital accounts evaluated against DNB checks? - Answers Initiate Billing. Additionally, some
may be configured to run at Discharge and each night through Min Days. If an account fails a DNB check,
it does not get billed and a DNB error or warning flag is applied to the account.
DNB checks - Answers Built using extension (LLP) records. Many are Epic-released records , so they can
be used as-is. If a custom DNB check is needed, then a Foundation System rule-based DNB check
extension can be duplicated to create a custom rule.
DNB check extension - Answers Can either hold the logic of the edit directly in the extension or be blank.
If the extension holds the logic, then a rule is not required unless filtering is desired. If the extension is
blank, then a rule is required.
Epic-released Extension (LPP) - Answers The Extension Record defines the problem, and is used when a
standard-released DNB check matches the edit checking needed with no modifications necessary.
Epic-released Extension (LPP) + Rule (CER) - Answers The Extension Record defines the problem, and is
used when a standard-released DNB check matches the edit checking needed but you want to limit
which hospital accounts are evaluated.
Shell Extension (custom copy or Foundation System LPP) + Rule (CER) - Answers The Rule Record (CER)
defines the problem. Used when a custom edit check is needed that is not already handled by any of the
standard or Foundation System extensions.
HSD-1 is automatically linked to the facility record, but what level hospital billing profile can be linked to
use the rule of specificity? - Answers Service area-level
