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CHAM EXAM 2026 QUESTIONS AND
ANSWERS| ACE YOUR GRADES| REVENUE
CYCLE, INSURANCE PLANS, PATIENT
ACCESS, BILLING COMPLIANCE, PAYER
POLICIES & HIPAA.
A patient who is admitted for an expected overnight stay or at
least 24 hours and is provided with room, board and continuous
general nursing services for diagnostic, surgical or medical
reasons. An inpatient must meet intensity of service/severity of
illness ("IS/SI") appropriateness criteria. The physician's
intent/order at the time of admission must have been for an
inpatient admission. If a patient is expected to stay overnight after
an invasive or surgical procedure and meets IS/SI criteria, the
patient is admitted as an inpatient. An individual who receives
healthcare services while admitted to the hospital overnight or
longer. - correct answer -Impatient
The process of determining coverage availability and benefits of
coverage. - correct answer -Insurance Verification
The individual who is the holder of healthcare coverage through
an insurance policy. - correct answer -Insured
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A health insurance plan or another entity that processes and pays
healthcare bills - correct answer -Insurer
A program that passes information from one system to another. -
correct answer -Interface
A private business, typically an insurance company, that contracts
with Centers for Medicare and Medicaid Services (CMS) to
receive, review and pay hospital and other institutional provider
benefit claims. - correct answer -Intermediary
An online computer network connecting companies, universities,
government agencies, healthcare systems, networks, users, etc.
Provides users the ability to access remote computers and send
and retrieve files. - correct answer -Internet
The record maintained by the health facility, hospital or
physician's office that details the charges made for services
rendered to patients and indicates whether an assignment of
benefits has been obtained. - correct answer -Itemized Statement
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An independent, not-for-profit organization, and is the nation's
oldest and largest standards-setting and health-care accrediting
body. The mission is to improve the quality of health-care for the
public by providing accreditation and related services that support
performance improvement in health-care organizations. - correct
answer -Joint Commission on Accreditation of Healthcare
Organizations (JCAHO)
The total number of patient days for an inpatient episode,
calculated by subtracting the date of admission from the date of
discharge - correct answer -Length of Stay (LOS)
insurance that pays for bodily injury and property damage. It
includes, but is not limited to, automobile insurance, uninsured
motorist insurance, malpractice insurance. - correct answer -
Liability Insurance
The total amount of money that an insurance company will pay
out on a single policy over the lifetime of the policy. Once
reached, the policyholder is responsible for all charges. - correct
answer -Lifetime Maximum
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the term for Medicare Part A coverage that entitles the beneficiary
to 60 days of inpatient coverage beyond the coinsurance day
benefit period. - correct answer -Lifetime Reserve Days (LRD)
Generally provided to the chronically ill or disabled in a nursing
facility or rest home. Among the services provided by nursing
facilities: 24-hour nursing care, rehabilitative services such as
physical and occupational therapy and speech therapy, as well as
assistance with activities of daily living. Coverage for nursing
facility care is available under both the Medicare and Medicaid
programs. Medicare beneficiaries are eligible for up to 100 days
of skilled nursing or rehabilitative care. Medicaid coverage is
available for those who have exhausted their own resources and
require public assistance to help pay for their care. - correct
answer -Long Term Care
A system wherein care is sharply controlled through the use of a
"gatekeeper" or prior authorization process. This type of plan
usually involves a preferred provider organization (PPO) in which
the patient has to use a provider contracted with the insurer to
accept an agreed-upon fee. - correct answer -Managed Care
an organization of medical doctors, hospitals and other health-
care providers who have covenanted with an insurer or a third-
party administrator to provide health-care at reduced rates to the
CHAM EXAM 2026 QUESTIONS AND
ANSWERS| ACE YOUR GRADES| REVENUE
CYCLE, INSURANCE PLANS, PATIENT
ACCESS, BILLING COMPLIANCE, PAYER
POLICIES & HIPAA.
A patient who is admitted for an expected overnight stay or at
least 24 hours and is provided with room, board and continuous
general nursing services for diagnostic, surgical or medical
reasons. An inpatient must meet intensity of service/severity of
illness ("IS/SI") appropriateness criteria. The physician's
intent/order at the time of admission must have been for an
inpatient admission. If a patient is expected to stay overnight after
an invasive or surgical procedure and meets IS/SI criteria, the
patient is admitted as an inpatient. An individual who receives
healthcare services while admitted to the hospital overnight or
longer. - correct answer -Impatient
The process of determining coverage availability and benefits of
coverage. - correct answer -Insurance Verification
The individual who is the holder of healthcare coverage through
an insurance policy. - correct answer -Insured
, Page | 2
A health insurance plan or another entity that processes and pays
healthcare bills - correct answer -Insurer
A program that passes information from one system to another. -
correct answer -Interface
A private business, typically an insurance company, that contracts
with Centers for Medicare and Medicaid Services (CMS) to
receive, review and pay hospital and other institutional provider
benefit claims. - correct answer -Intermediary
An online computer network connecting companies, universities,
government agencies, healthcare systems, networks, users, etc.
Provides users the ability to access remote computers and send
and retrieve files. - correct answer -Internet
The record maintained by the health facility, hospital or
physician's office that details the charges made for services
rendered to patients and indicates whether an assignment of
benefits has been obtained. - correct answer -Itemized Statement
, Page | 3
An independent, not-for-profit organization, and is the nation's
oldest and largest standards-setting and health-care accrediting
body. The mission is to improve the quality of health-care for the
public by providing accreditation and related services that support
performance improvement in health-care organizations. - correct
answer -Joint Commission on Accreditation of Healthcare
Organizations (JCAHO)
The total number of patient days for an inpatient episode,
calculated by subtracting the date of admission from the date of
discharge - correct answer -Length of Stay (LOS)
insurance that pays for bodily injury and property damage. It
includes, but is not limited to, automobile insurance, uninsured
motorist insurance, malpractice insurance. - correct answer -
Liability Insurance
The total amount of money that an insurance company will pay
out on a single policy over the lifetime of the policy. Once
reached, the policyholder is responsible for all charges. - correct
answer -Lifetime Maximum
, Page | 4
the term for Medicare Part A coverage that entitles the beneficiary
to 60 days of inpatient coverage beyond the coinsurance day
benefit period. - correct answer -Lifetime Reserve Days (LRD)
Generally provided to the chronically ill or disabled in a nursing
facility or rest home. Among the services provided by nursing
facilities: 24-hour nursing care, rehabilitative services such as
physical and occupational therapy and speech therapy, as well as
assistance with activities of daily living. Coverage for nursing
facility care is available under both the Medicare and Medicaid
programs. Medicare beneficiaries are eligible for up to 100 days
of skilled nursing or rehabilitative care. Medicaid coverage is
available for those who have exhausted their own resources and
require public assistance to help pay for their care. - correct
answer -Long Term Care
A system wherein care is sharply controlled through the use of a
"gatekeeper" or prior authorization process. This type of plan
usually involves a preferred provider organization (PPO) in which
the patient has to use a provider contracted with the insurer to
accept an agreed-upon fee. - correct answer -Managed Care
an organization of medical doctors, hospitals and other health-
care providers who have covenanted with an insurer or a third-
party administrator to provide health-care at reduced rates to the
