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CHAM VERIFIED EXAM QUESTIONS &
ANSWERS | 2026 QUESTIONS AND
ANSWERS| ACE YOUR GRADES|
INSURANCE PLANS, COMPLIANCE,
REGISTRATION, REVENUE CYCLE, PAYER
POLICIES & PATIENT RIGHTS.
Respite Care - correct answer -Short-term care provided at home,
in a long-term care facility, at a community-based center, or in a
hospital when another setting is not available. allows families
caring for elders or other mentally or physically dependent family
members time off in their care giving responsibilities. This type of
care is not reimbursable through Medicare or Medicaid.
Revenue Code - correct answer -Codes established by the Health
Care Financing Administration (HCFA) submitted on HCFA
standard forms to identify hospital and ancillary services. defined
as the charges generated as patients are given care. submitted
on the Uniform Billing Code (UB-04) to identify an inpatient
accommodation code or and ancillary charge.
Revenue Cycle - correct answer -All administrative and clinical
functions that contribute to the capture and presentation of patient
services for payment.
, Page | 2
Risk (contract) - correct answer -A contractual agreement wherein
all healthcare services are provided for a fixed monthly payment
for all members enrolled. The providers are at financial risk for all
services that are provided.
Routine - correct answer -A standard set of procedures or
activities.
Secondary Insurance Care - correct answer -A second third-party
insurance plan to cover expenses not paid by the primary payer.
Services provided by medical specialists, such as cardiologists,
urologists, etc. Generally, they are not the patient's first contact.
Secondary Payer - correct answer -the insurer or entity with
second priority for payment of a bill, after the primary payer.
Self-Administered Drugs (SAD) - correct answer -are oral or
topical medications identified by Medicare as drugs that can be
administered by the Patient in an outpatient setting and are not
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payable by Medicare. Examples are aspirin or an antibiotic
ointment.
Self-Funded Plan - correct answer -Managed Care Organization
(MCO) or insurance company, is financially responsible for paying
plan expenses, including claims made by group plan members.
Also known as a self-insured plan.
Self-Pay - correct answer -The portion of the bill that is to be paid
in-part or in-full by the responsible party from their own resources,
as it is not payable by a third party.
Share of Cost (SOC) - correct answer -The amount a patient
covered by Medicaid must pay for eligible medical expenses out
of their pocket. The amount varies according to the patient's
current maintenance or financial status. Verification through the
Medicaid system is required for each patient visit.
Skilled Nursing Facility (SNF) - correct answer -A facility that
primarily provides inpatient skilled nursing services to patients
who require medical, nursing or rehabilitative services but does
not provide the level of care or treatment available in a hospital.
, Page | 4
Sponsor - correct answer -The individual who initiates healthcare
coverage through an employer, private health plan or other payer
can be called the insured, subscriber, policyholder or _____.
Standard of Care - correct answer -A diagnostic and treatment
process that a clinician should follow for a certain type of patient,
illness or clinical circumstance.
State Children's Health Insurance Program (SCHIP) - correct
answer -State Children's Health Insurance Program (SCHIP)
State Health Insurance Assistance Program - correct answer -A
State organization that receives money from the Federal
Government to give free health insurance counseling and
assistance to Medicare beneficiaries.
Stop-Loss Provision - correct answer -A form of contracted
payment that allows for a higher claim payment for a qualifying
catastrophic hospitalization. For example, a hospital may have a
_______ in its contract with the insurance company for accounts
that exceed $100,000.00. After an account hits $100,000.00, the
CHAM VERIFIED EXAM QUESTIONS &
ANSWERS | 2026 QUESTIONS AND
ANSWERS| ACE YOUR GRADES|
INSURANCE PLANS, COMPLIANCE,
REGISTRATION, REVENUE CYCLE, PAYER
POLICIES & PATIENT RIGHTS.
Respite Care - correct answer -Short-term care provided at home,
in a long-term care facility, at a community-based center, or in a
hospital when another setting is not available. allows families
caring for elders or other mentally or physically dependent family
members time off in their care giving responsibilities. This type of
care is not reimbursable through Medicare or Medicaid.
Revenue Code - correct answer -Codes established by the Health
Care Financing Administration (HCFA) submitted on HCFA
standard forms to identify hospital and ancillary services. defined
as the charges generated as patients are given care. submitted
on the Uniform Billing Code (UB-04) to identify an inpatient
accommodation code or and ancillary charge.
Revenue Cycle - correct answer -All administrative and clinical
functions that contribute to the capture and presentation of patient
services for payment.
, Page | 2
Risk (contract) - correct answer -A contractual agreement wherein
all healthcare services are provided for a fixed monthly payment
for all members enrolled. The providers are at financial risk for all
services that are provided.
Routine - correct answer -A standard set of procedures or
activities.
Secondary Insurance Care - correct answer -A second third-party
insurance plan to cover expenses not paid by the primary payer.
Services provided by medical specialists, such as cardiologists,
urologists, etc. Generally, they are not the patient's first contact.
Secondary Payer - correct answer -the insurer or entity with
second priority for payment of a bill, after the primary payer.
Self-Administered Drugs (SAD) - correct answer -are oral or
topical medications identified by Medicare as drugs that can be
administered by the Patient in an outpatient setting and are not
, Page | 3
payable by Medicare. Examples are aspirin or an antibiotic
ointment.
Self-Funded Plan - correct answer -Managed Care Organization
(MCO) or insurance company, is financially responsible for paying
plan expenses, including claims made by group plan members.
Also known as a self-insured plan.
Self-Pay - correct answer -The portion of the bill that is to be paid
in-part or in-full by the responsible party from their own resources,
as it is not payable by a third party.
Share of Cost (SOC) - correct answer -The amount a patient
covered by Medicaid must pay for eligible medical expenses out
of their pocket. The amount varies according to the patient's
current maintenance or financial status. Verification through the
Medicaid system is required for each patient visit.
Skilled Nursing Facility (SNF) - correct answer -A facility that
primarily provides inpatient skilled nursing services to patients
who require medical, nursing or rehabilitative services but does
not provide the level of care or treatment available in a hospital.
, Page | 4
Sponsor - correct answer -The individual who initiates healthcare
coverage through an employer, private health plan or other payer
can be called the insured, subscriber, policyholder or _____.
Standard of Care - correct answer -A diagnostic and treatment
process that a clinician should follow for a certain type of patient,
illness or clinical circumstance.
State Children's Health Insurance Program (SCHIP) - correct
answer -State Children's Health Insurance Program (SCHIP)
State Health Insurance Assistance Program - correct answer -A
State organization that receives money from the Federal
Government to give free health insurance counseling and
assistance to Medicare beneficiaries.
Stop-Loss Provision - correct answer -A form of contracted
payment that allows for a higher claim payment for a qualifying
catastrophic hospitalization. For example, a hospital may have a
_______ in its contract with the insurance company for accounts
that exceed $100,000.00. After an account hits $100,000.00, the
