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CHAM 2025/2026 – 120+ Verified Exam Questions & Answers | Insurance Plans, Compliance, Registration, Revenue Cycle, Payer Policies & Patient Rights

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This CHAM (Certified Healthcare Access Manager) 2025/2026 study guide includes 120+ expertly verified questions and detailed answers, offering a complete overview of the exam domains required by NAHAM standards. With a strong focus on real-world scenarios and administrative functions, this guide helps professionals excel in patient access leadership and healthcare financial services. Covered topics include: Health Insurance Systems & Payer Models: Medicare, Medicaid, TRICARE, PPO, HMO, Fee-for-Service, Point-of-Service, Open Access, Capitation Healthcare Compliance & Regulations: HIPAA, No Balance Billing, OIG, COBRA, CMS, HCFA, OBRA, fraud prevention Patient Access Operations: Pre-registration, authorization, verification of benefits, registration workflows, encounter documentation Medical Billing & Claims: HCFA 1500, UB-04, CMS-1450, DRG, CPT codes, A/R processes, co-pay/deductibles, claim submissions Patient Rights & Support: Consent, communication, confidentiality, family liaison, education and satisfaction measurements Operational Efficiency: Benchmarking, customer service, productivity, admission discharge transfer (ADT), encounter tracking, statistical reporting Emergency & Specialized Care Coordination: Critical Access Hospitals, managed care policies, custodial vs acute care, respite care, disaster planning Who this is for: CHAM exam candidates preparing for 2025/2026 NAHAM certification Patient Access Managers, Supervisors & Revenue Cycle Analysts Healthcare Administration, Health Services, and Public Health students (undergraduate or graduate level) Medical billing, insurance coordination, and healthcare compliance professionals Hospital operations teams working with ADT, billing, and compliance workflows Whether you’re looking to earn your CHAM certification or solidify your knowledge of healthcare access operations, this guide offers a deep, organized review of the terms, acronyms, policies, and workflows central to patient access success. Keywords: CHAM exam, NAHAM certification, patient access management, revenue cycle, payer models, insurance verification, HIPAA compliance, CPT coding, HCFA 1500, CMS 1450, pre-registration, billing process, healthcare fraud, COBRA, DRG system, customer satisfaction, benchmarking, A/R process, registration workflow, managed care, healthcare regulation

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CHAM 2025/2026 Exam Questions with
Detailed Verified Answers (100% Correct
Answers) | Already Graded A+



Accepting Assignment - 🧠 ANSWER ✔✔When a provider agrees to accept the

allowable charges as the full fee and cannot charge the patient the difference

between the insurance payment and the provider's normal fee.


Access - 🧠 ANSWER ✔✔The patient's ability to obtain medical care. The ease is

determined by such components as the availability of medical services and their

acceptability to the patient, the location of health-care facilities, transportation,

hours of operation and cost of care.


Account Number - 🧠 ANSWER ✔✔A number assigned to each account. This

number is used to identify the account and all charges and payments received.

,Acute Care - 🧠 ANSWER ✔✔Medical attention given to patients with conditions

of sudden onset that demand urgent attention or care of limited duration when the

patient's health and wellness would deteriorate without treatment. This care is

generally short-term rather than long-term or chronic care.


Acute Impatient Care - 🧠 ANSWER ✔✔A level of healthcare delivered to patients

experiencing acute illness or trauma. Generally short-term (<30 days).


Add Ons - 🧠 ANSWER ✔✔Patients who are scheduled for services less than 24

hours in advance of the actual service time.


Adjustor - 🧠 ANSWER ✔✔Insurance company representative.


Administrative Costs - 🧠 ANSWER ✔✔Costs associated with creating and

submitting a bill for services, which could include: registration, utilization review,

coding, billing, and collection expenses.


Admission Authorization - 🧠 ANSWER ✔✔The process of third-party payer

notification of urgent/emergent inpatient admission within specified time as

determined by payers (usually 24-48 hours or next business day).


Admission Date - 🧠 ANSWER ✔✔The first date the patient entered the hospital for

a specific visit.

,Admitting Diagnosis - 🧠 ANSWER ✔✔Word, phrase, or International

Classification of Disease (ICD10) code used by the admitting physician to identify

a condition or disease from which a patient suffers and for which the patient needs

or seeks medical care.


Admitting Physician - 🧠 ANSWER ✔✔The physician who writes the order for the

patient to be admitted to the hospital. The physician must have admitting privileges

at the facility providing the healthcare services.


Advance Beneficiary Notice - 🧠 ANSWER ✔✔A notice that a care provider should

give a Medicare beneficiary to sign if the services being provided may not be

considered medically necessary and Medicare may not pay for them. Allows the

beneficiary to make an informed decision prior to services regarding whether or

not they wish to receive services. Are not routinely given to emergency department

patients.


Advance Directive - 🧠 ANSWER ✔✔A written instruction relating to the provision

of healthcare when a patient is incapacitated. It could include appointing someone

to make medical decisions, a statement expressing the patient's wishes about

anatomical gifts (i.e. organ donation) and general statements about whether or not

life sustaining treatments should be withheld or withdrawn.



COPYRIGHT©NINJANERD 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE.
PRIVACY STATEMENT. ALL RIGHTS RESERVED



3

, Adverse Selection - 🧠 ANSWER ✔✔Among applicants for a given group or

individual program, the tendency for those with an impaired health status, or who

are prone to higher than average utilization of benefits to be enrolled in

disproportionate number and lower deductibles.


Alias - 🧠 ANSWER ✔✔A name by which the patient is also "known as", or

formerly known as.

All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) - 🧠

ANSWER ✔✔A prospective hospital claims reimbursement system currently

utilized by the federal government Medicaid program and the states of New York

and New Jersey. Designed to describe the complete cross section of patients seen

in acute care hospitals. Approximately 639 are defined according to the principal

diagnosis, secondary diagnoses, procedures, age, birth weight, sex and discharge

status. Each category has an established fixed reimbursement rate based on average

cost of treatment within a geographic area. Were developed to quantify the

difference in demographic groups and clinical risk factors for patients treated in

hospitals. This proprietary grouping system's (i.e. 3M) purpose is to obtain fair and

accurate statistical comparisons between disparate populations and groups. Unlike

the Diagnosis Related Group (DRG) reimbursement system, which is intended to

capture resource utilization intensity, this system captures and relates the severity

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