EPIC Resolute Hospital Billing Fundamentals Practice Test

The key idea here is understanding what gets charged to the patient after an insurance claim is processed. Once the payer adjudicates a claim, the amount the patient ultimately owes is the remaining balance after the insurer pays its part. In Resolute posting terms, that remaining balance is called the Patient Responsibility. This includes things like deductibles, coinsurance, copays, and any portions not covered by the plan. When the account shifts to self-pay or to secondary coverage, the amount that must be collected from the patient is precisely this patient responsibility. Not Allowed Amount refers to funds the payer will not cover due to contract limits, which isn’t the amount the patient pays in most standard scenarios. The Allowed Amount is the maximum the payer will reimburse under the contract, not the amount the patient owes. A Follow-Up Record is a tracking entry, not a money amount. So, the amount passed on to the patient under self-pay or secondary coverage is the Patient Responsibility.