Revenue Cycle
Often the first step in the cycle, this process involves verifying a patient's insurance coverage and benefits before services are rendered
What is Eligibility Verification?
This module is used for professional billing (physician services), while its counterpart, HB, is used for hospital/technical charges.
What is Resolute PB?
This diverse group of departments that we work with (CHHA, STARS, Infusion, Hospice, Lab, CEMS, and SNF); notably, Continuing Care and SNF are / will be on Epic, services like CEMS and Lab will not be.
What are the Ancillary Businesses?
This is the primary status a Hospital Account (HAR) sits in while it waits for all clinical documentation, coding, and the "Min Days" to pass before a claim can be generated.
What is CFB (Candidate for Bill)?
This type of Workqueue is the most common in the revenue cycle; it holds accounts that have hit a "stop sign" due to errors in registration, coding, or insurance.
What is an Account Workqueue?
This set of standardized codes is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians and health insurance companies.
What are CPT Codes?
This self-service tool allows revenue cycle managers to "slice and dice" high-level data into populations, identifying trends like high-dollar denials or aging accounts without writing SQL.
What is SlicerDicer?
Calculated by counting the volume of all untouched claims that are aged more than 45 days post billing, plus the volume of claims that have a tickler that expires that day of follow-up.
What is WIP?
This is the total post discharge unbilled amount of AR (suspense period $ + CFB $ = ?)
What is DNFB? (Discharged Not Final Billed)?
These are the specific "criteria" or logic used to determine which records enter a workqueue and which users are allowed to see them.
What are Rules?
This metric represents the percentage of claims that are successfully processed and paid by the payer upon their very first submission
What is the Clean Claim Rate?
These specific tools in Epic's "Claims" module act as a safety net, stopping a claim from being sent to a payer if it fails certain pre-defined validation logic.
What are Claim Edits (or Claim Edit Workqueues)?
When conducting an assessment, these three specific pillars—measuring how much work is done, how quickly it is addressed, and whether the resolution was correct the first time—are considered the "The Trifecta".
What are Productivity, Timely Touches, and Quality Actions?
These specific errors within a procedural log prevent it from being finalized and posted; while they contribute to the CFB total and are tracked in specific workqueues for transparency, they cannot be directly "worked" from a WQ.
hat are Unposted Logs?
These specific workqueues catch "dirty" claims after a HAR leaves CFB but before the 837 file is sent to the clearinghouse; they are often divided by payer or error type (e.g., "Medicare Missing Info").
What are Claim Edit Workqueues?
Unlike a "rejection," which happens at the clearinghouse, this occurs when a payer processes a claim and decides not to pay it due to a specific policy or data error.
What is a Denial?
In Epic's data hierarchy, this is the entity that groups one or more encounters for billing purposes, effectively acting as the "folder" for charges and payments.
What is a HAR (Hospital Account Record)?
This specific framework suggests that a successful Revenue Cycle assessment must evaluate the staff's skills, the manual and automated workflows, and the software tools being utilized.
What is People, Process, and Technology?
If a charge is sent to the wrong HAR or contains an error while still in the CFB window, a user might use this activity to move or "undo" the charge before it ever hits a claim.
What is Charge Router / Charge Review?
In order for workqueues to get a Grouper 4, which helps with reporting, they must get this assigned to them.
What is a workqueue supervisor?
This accounting metric, calculated by dividing the total accounts receivable by the average daily gross revenue, measures how long it takes a facility to get paid.
What is AR Days?
Unlike Clarity, this real-time reporting tool pulls data directly from Chronicles and allows users to take immediate action on results, such as jumping straight into a billing workqueue.
What is Reporting Workbench (or RWB)?
This recurring meeting reviews a monthly dashboard of KPIs—specifically focusing on Write-offs, Cash Collections, % of AR over 90 days, etc. to identify revenue leakage and ensure budgeted initiative goals are reached.
What is the Ancillary Monthly Meeting?
In Reporting Workbench, this specific type of "Snapshot" or "Trended" report is used by leadership to monitor the total dollar value of all accounts currently stuck in CFB to manage workqueue volumes.
What is a CFB Report?
After a claim is sent and a denial is received, these workqueues use "Follow-up Records" to route the denied claim to a specific user's desk based on the Reason Code provided by the payer.
What are Follow-up Workqueues?