CHAM EXAM 2025 QUESTIONS AND
ANSWERS
Accepting Assignment - ANS 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 - ANS 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 - ANS A number assigned to each account. This number is used to identify
the account and all charges and payments received.
Acute Care - ANS 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 - ANS A level of healthcare delivered to patients experiencing acute
illness or trauma. Generally short-term (<30 days).
Add Ons - ANS Patients who are scheduled for services less than 24 hours in advance of the
1
actual service time.
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@COPYRIGHT @THEBRIGHT 2025/2026
, Adjustor - ANS Insurance company representative.
Administrative Costs - ANS Costs associated with creating and submitting a bill for services,
which could include: registration, utilization review, coding, billing, and collection expenses.
Admission Authorization - ANS 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 - ANS The first date the patient entered the hospital for a specific visit.
Admitting Diagnosis - ANS 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 - ANS 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 - ANS 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 - ANS 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.
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, Adverse Selection - ANS 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 - ANS A name by which the patient is also "known as", or formerly known as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) - ANS 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 of illness and risk of mortality factors present as a result of a patient's
disease and disorders and the interaction of those disorders. A form is signed by the patient
giving the healthcare provider authority to bill his/her insurance plan and receive payment. The
form is generally presented and signed at the time of registration.
Alphanumeric - ANS Letters, numbers, punctuation marks and mathematical symbols, as
opposed to "numeric" which is numbers only. Term typically related to the kind of data
accepted in a computer field or in coding.
Ambulatory Care Patient - ANS Patient receives medical or surgical care in an outpatient
setting that involves a broader, less specialized range of care. Ambulatory patients are generally
able to walk and are not confined to a bed. In a hospital setting, ambulatory care generally
refers to healthcare services provided on an outpatient basis.
Ambulatory Payment Classification (APC) - ANS A system of averaging and bundling using
Current Procedural Terminology (CPT) procedure codes, Healthcare Common Procedure Coding
3
System (HCPCS) Level II, and revenue codes submitted for payment. The ______ system utilizes
Page
groups of CPT codes based on clinical and resource similarity and establishes payment rates for
@COPYRIGHT @THEBRIGHT 2025/2026
, each ______ grouping. The 650+ ______ are divided by significant procedures, medical services,
ancillary services and partial hospitalization services. The ______ are similar clinically, by
resources uses and cost.
Ambulatory Surgical Center - ANS A freestanding facility, other than a physician's office,
where surgical, diagnostic, and therapeutic services are provided on an outpatient ambulatory
basis.
Ancillary Services - ANS A unit of the hospital, other than a nursing unit, that provides
medical services such as diagnostic testing and therapeutic procedures, or dispenses medical
products, such as medications or medical/surgical supplies. Examples: Laboratory, Medical
Imaging, Physical Therapy and Pharmacy. Ancillary is used to describe diagnostic or therapeutic
services, such as laboratory, radiology, pharmacy, or physical therapy, performed by
departments that do not have inpatient beds.
Annual Maximum Benefit Amount Deductible - ANS The maximum dollar amount set by a
Managed Care Organization (MCO) that limits the total amount the plan must pay for all health
care services provided to a subscriber in a year.
A deductible is the set amount, per benefit year or period, that the third party payer designates
as the patient/guarantors responsibility. Usually the deductible must be paid before the
benefits will be paid by the payer.
Appeal - ANS A special kind of complaint made when a beneficiary or provider disagrees with
decisions about healthcare services-typically related to payment issues. There is usually a
special process used to appeal payer decisions.
Appropriate Care - ANS A diagnostic or treatment measure whose expected health benefits
exceed its expected health risks by a wide enough margin to justify the measure.
Assignment of Benefit - ANS Written authorization from the policyholder for their insurance
company to pay benefits directly to the care provider. Normally acquired at the time of
admission or registration.
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Page
@COPYRIGHT @THEBRIGHT 2025/2026
ANSWERS
Accepting Assignment - ANS 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 - ANS 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 - ANS A number assigned to each account. This number is used to identify
the account and all charges and payments received.
Acute Care - ANS 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 - ANS A level of healthcare delivered to patients experiencing acute
illness or trauma. Generally short-term (<30 days).
Add Ons - ANS Patients who are scheduled for services less than 24 hours in advance of the
1
actual service time.
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Adjustor - ANS Insurance company representative.
Administrative Costs - ANS Costs associated with creating and submitting a bill for services,
which could include: registration, utilization review, coding, billing, and collection expenses.
Admission Authorization - ANS 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 - ANS The first date the patient entered the hospital for a specific visit.
Admitting Diagnosis - ANS 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 - ANS 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 - ANS 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 - ANS 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.
2
Page
@COPYRIGHT @THEBRIGHT 2025/2026
, Adverse Selection - ANS 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 - ANS A name by which the patient is also "known as", or formerly known as.
All Patient Diagnosis Related Groups Assignment of Benefits (APDRG) - ANS 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 of illness and risk of mortality factors present as a result of a patient's
disease and disorders and the interaction of those disorders. A form is signed by the patient
giving the healthcare provider authority to bill his/her insurance plan and receive payment. The
form is generally presented and signed at the time of registration.
Alphanumeric - ANS Letters, numbers, punctuation marks and mathematical symbols, as
opposed to "numeric" which is numbers only. Term typically related to the kind of data
accepted in a computer field or in coding.
Ambulatory Care Patient - ANS Patient receives medical or surgical care in an outpatient
setting that involves a broader, less specialized range of care. Ambulatory patients are generally
able to walk and are not confined to a bed. In a hospital setting, ambulatory care generally
refers to healthcare services provided on an outpatient basis.
Ambulatory Payment Classification (APC) - ANS A system of averaging and bundling using
Current Procedural Terminology (CPT) procedure codes, Healthcare Common Procedure Coding
3
System (HCPCS) Level II, and revenue codes submitted for payment. The ______ system utilizes
Page
groups of CPT codes based on clinical and resource similarity and establishes payment rates for
@COPYRIGHT @THEBRIGHT 2025/2026
, each ______ grouping. The 650+ ______ are divided by significant procedures, medical services,
ancillary services and partial hospitalization services. The ______ are similar clinically, by
resources uses and cost.
Ambulatory Surgical Center - ANS A freestanding facility, other than a physician's office,
where surgical, diagnostic, and therapeutic services are provided on an outpatient ambulatory
basis.
Ancillary Services - ANS A unit of the hospital, other than a nursing unit, that provides
medical services such as diagnostic testing and therapeutic procedures, or dispenses medical
products, such as medications or medical/surgical supplies. Examples: Laboratory, Medical
Imaging, Physical Therapy and Pharmacy. Ancillary is used to describe diagnostic or therapeutic
services, such as laboratory, radiology, pharmacy, or physical therapy, performed by
departments that do not have inpatient beds.
Annual Maximum Benefit Amount Deductible - ANS The maximum dollar amount set by a
Managed Care Organization (MCO) that limits the total amount the plan must pay for all health
care services provided to a subscriber in a year.
A deductible is the set amount, per benefit year or period, that the third party payer designates
as the patient/guarantors responsibility. Usually the deductible must be paid before the
benefits will be paid by the payer.
Appeal - ANS A special kind of complaint made when a beneficiary or provider disagrees with
decisions about healthcare services-typically related to payment issues. There is usually a
special process used to appeal payer decisions.
Appropriate Care - ANS A diagnostic or treatment measure whose expected health benefits
exceed its expected health risks by a wide enough margin to justify the measure.
Assignment of Benefit - ANS Written authorization from the policyholder for their insurance
company to pay benefits directly to the care provider. Normally acquired at the time of
admission or registration.
4
Page
@COPYRIGHT @THEBRIGHT 2025/2026
