MEAS 137 FINAL REVIEW WORKSHEET 2026/2027 – OUTPATIENT
INSURANCE & BASIC CODING STUDY GUIDE & EXAM PREP
Medical insurance specialists ensure financial success of the medical practice by: - ✔✔using health
information technology
In a medical practice, cash flow is required to - ✔✔pay for office expenses
Examine the list of services and determine which one would most likely be considered a noncovered
service. - ✔✔employment related injuries
Determine which of the following entities is not considered a provider. - ✔✔insurance companies
Identify the type of service that is not considered to be a preventive medical service. - ✔✔outpatient
surgery
Determine which of the following types of services a health plan will not pay for - ✔✔noncovered
services
What is the formula for calculating an insurance company payment in an indemnity plan? - ✔✔charge-
deductible-coinsurance
Identify the type of HMO cost-containment method that requires the patient to pay a copayment. -
✔✔cost-sharing
Identify the type of HMO cost-containment method that requires patients to obtain approval for services
before they receive the treatment - ✔✔requiring preauthorization for services
If a POS HMO member elects to receive medical services from out-of-network providers they usually -
✔✔pay for additional cost
Which of the following is required when an HMO patient is admitted to the hospital for nonemergency
treatment? - ✔✔preauthorization
One of the advantages of an HMO for patients who face difficult treatments is Disease/Case
Management by assigning a: - ✔✔caseworker
A physician has a contract to receive a $2,000 monthly capitation fee, based on a fee of $50 for 40
patients who are in the plan. If only 10 patients visited the practice in the last month, the capitation
payment will be - ✔✔$2000
Describe the process of adjudication. - ✔✔the payer's process of putting a claim through a series of
steps designed to judge whether it should be paid
Pick the most accurate definition of certification. - ✔✔recognition of a superior level of skill by an
official organization
, Under what rule is a child's primary coverage under the father's plan when both parents have coverage?
- ✔✔gender rule
Financial policies usually contain the following information: - ✔✔credit policy, insufficient funds
payment policy, and insurance information
What should be verified when someone requests PHI for TPO purposes? - ✔✔the identity of the person
and person's authority to access PHI
The document patients sign to signify that they have read and understood how the provider will protect
their PHI is the - ✔✔Acknowledgment of Receipt of Notice of Privacy Practices.
Patients will have the same chart number when - ✔✔none of these; chart numbers are unique
Determine how a policyholder can authorize physicians to submit claims on their behalf and receive
payments directly from payers - ✔✔signing and dating an assignment of benefits statement
If the practice accepts credit and debit cards it must: - ✔✔pay a fee to the credit card company
The document patients sign to signify that they have read and understood how the provider will protect
their PHI is the - ✔✔Acknowledgment of Receipt of Notice of Privacy Practices.
Who typically documents the patient's vital signs? - ✔✔Clinical Medical Assistant
A "self-pay" patient is one who: - ✔✔is uninsured
ICD-10-CM was mandated under the HIPAA - ✔✔Transactions and Code Sets
As of October 1, 2015, the diagnosis codes that must be used in the United States are based on which of
the following revisions of the International Classification of Diseases (ICD)? - ✔✔10th revision
A code in ICD-10-CM has how many characters? - ✔✔3 to 7
A subcategory code in ICD-10-CM is how many characters? - ✔✔4 to 5
When coding in ICD-10-CM, if the syndrome is not identified, which of the following should you use? -
✔✔Manifestations
The Alphabetic Index is also known as the: - ✔✔ICD-10-CM Index to Disease and Injuries
The federal government has used ICD-10 to categorize what since 1999? - ✔✔mortality data
Updates to ICD-10-CM are called: - ✔✔addenda
The first step in the coding process is to look in the: - ✔✔Alphabetic Index
INSURANCE & BASIC CODING STUDY GUIDE & EXAM PREP
Medical insurance specialists ensure financial success of the medical practice by: - ✔✔using health
information technology
In a medical practice, cash flow is required to - ✔✔pay for office expenses
Examine the list of services and determine which one would most likely be considered a noncovered
service. - ✔✔employment related injuries
Determine which of the following entities is not considered a provider. - ✔✔insurance companies
Identify the type of service that is not considered to be a preventive medical service. - ✔✔outpatient
surgery
Determine which of the following types of services a health plan will not pay for - ✔✔noncovered
services
What is the formula for calculating an insurance company payment in an indemnity plan? - ✔✔charge-
deductible-coinsurance
Identify the type of HMO cost-containment method that requires the patient to pay a copayment. -
✔✔cost-sharing
Identify the type of HMO cost-containment method that requires patients to obtain approval for services
before they receive the treatment - ✔✔requiring preauthorization for services
If a POS HMO member elects to receive medical services from out-of-network providers they usually -
✔✔pay for additional cost
Which of the following is required when an HMO patient is admitted to the hospital for nonemergency
treatment? - ✔✔preauthorization
One of the advantages of an HMO for patients who face difficult treatments is Disease/Case
Management by assigning a: - ✔✔caseworker
A physician has a contract to receive a $2,000 monthly capitation fee, based on a fee of $50 for 40
patients who are in the plan. If only 10 patients visited the practice in the last month, the capitation
payment will be - ✔✔$2000
Describe the process of adjudication. - ✔✔the payer's process of putting a claim through a series of
steps designed to judge whether it should be paid
Pick the most accurate definition of certification. - ✔✔recognition of a superior level of skill by an
official organization
, Under what rule is a child's primary coverage under the father's plan when both parents have coverage?
- ✔✔gender rule
Financial policies usually contain the following information: - ✔✔credit policy, insufficient funds
payment policy, and insurance information
What should be verified when someone requests PHI for TPO purposes? - ✔✔the identity of the person
and person's authority to access PHI
The document patients sign to signify that they have read and understood how the provider will protect
their PHI is the - ✔✔Acknowledgment of Receipt of Notice of Privacy Practices.
Patients will have the same chart number when - ✔✔none of these; chart numbers are unique
Determine how a policyholder can authorize physicians to submit claims on their behalf and receive
payments directly from payers - ✔✔signing and dating an assignment of benefits statement
If the practice accepts credit and debit cards it must: - ✔✔pay a fee to the credit card company
The document patients sign to signify that they have read and understood how the provider will protect
their PHI is the - ✔✔Acknowledgment of Receipt of Notice of Privacy Practices.
Who typically documents the patient's vital signs? - ✔✔Clinical Medical Assistant
A "self-pay" patient is one who: - ✔✔is uninsured
ICD-10-CM was mandated under the HIPAA - ✔✔Transactions and Code Sets
As of October 1, 2015, the diagnosis codes that must be used in the United States are based on which of
the following revisions of the International Classification of Diseases (ICD)? - ✔✔10th revision
A code in ICD-10-CM has how many characters? - ✔✔3 to 7
A subcategory code in ICD-10-CM is how many characters? - ✔✔4 to 5
When coding in ICD-10-CM, if the syndrome is not identified, which of the following should you use? -
✔✔Manifestations
The Alphabetic Index is also known as the: - ✔✔ICD-10-CM Index to Disease and Injuries
The federal government has used ICD-10 to categorize what since 1999? - ✔✔mortality data
Updates to ICD-10-CM are called: - ✔✔addenda
The first step in the coding process is to look in the: - ✔✔Alphabetic Index
