CHAM COMPREHENSIVE EXAM 2026/2027 QUESTIONS
AND SOLUTIONS RATED A+
✔✔Diagnosis Related Group (DRG) - ✔✔System for classification for over 490
diagnoses based on patterns in resource consumption and length of stay. Used in many
prospective payment plans including Medicare. Classify all human diseases according
to the affected organ system, surgical procedures performed, disposition and gender of
the patient. Currently, there are over 500 active _______ within the inpatient
prospective pricing methodology. A flat rate is paid per inpatient stay based on the
assigned _______ .
✔✔Discharge Planning - ✔✔Medical personnel of the health plan work with the
attending physician and hospital staff to assess alternatives to hospitalization, evaluate
appropriate settings for care and arrange for discharge of a patient, including planning
for subsequent care at home or in a skilled nursing facility.
✔✔Discounted Fee-for-Service - ✔✔An agreed-upon rate for service between the
provider and payer that is usually less than the provider's full fee. This may be a fixed
amount per service, or a percentage discount.
✔✔Donor - ✔✔One from whom blood, tissue or an organ is taken for use in a
transfusion or transplant.
✔✔Durable Medical Equipment (DME) - ✔✔Typically withstands repeated use,
improves function or retards further deterioration of a physical condition, and primarily
provides a medical function. (Ex: Hospital bed; wheelchair)
✔✔Durable Power of Attorney for Healthcare - ✔✔A legally assigned individual that is
empowered to make medical treatment decisions on the patient's behalf if the patient is
incapacitated and cannot speak for them self. Also known as a Healthcare Agent or
Proxy.
✔✔Effective Dates Insurance - ✔✔The beginning and ending dates for which third-party
financial responsibility is enforced. Any service dates before or after these dates will not
be covered by a particular third party.
✔✔Electronic Media - ✔✔The storage and transmission tools used to store and deliver
information or data and utilizes electronics or electromechanical energy for the end user
to access the content.
✔✔Eligibility - ✔✔The act of confirming a person's status with the employer or union. A
person who is entitled to benefits according to an employer or union, and is currently
covered by insurance.
,✔✔Eligible Dependent - ✔✔A dependent of a covered employee who meets the
requirements specified in the group contract to qualify for coverage and for whom
premium payment is made.
✔✔Eligible Expenses - ✔✔Reasonable and customary charges, or the agreed upon fee
for health services and supplies covered under a health plan.
✔✔Email - ✔✔a telecommunications system that enables users to send messages
prepared on a computer to another computer user. Telephone lines are generally used
to send the signal from terminal to terminal. Files may be sent via _______ but the
recipient must have compatible software to open them.
✔✔Emancipation - ✔✔Legal term that means a child is no longer under the control of
the parent. The definition varies from state to state.meaning they have been released
from their parents' control and supervision and are responsible for themselves. _______
minors are their own guarantors.
✔✔Emergency Care Patient - ✔✔Patients examined on an unscheduled basis for
immediate diagnosis and treatment in the emergency facilities of the hospital. They are
not admitted for inpatient service. An individual who receives immediate medical
attention through the Emergency department.
✔✔Emergency Medical Treatment and Active Labor Act (EMTALA) - ✔✔A statute that
governs when and how a patient may be (1) refused treatment or (2) transferred from
one hospital to another when they are in an unstable medical condition. Also known as
the anti-dumping law.
✔✔Employer Group Health Plan (EGHP) - ✔✔Health insurance provided through an
employer.
✔✔Encounter - ✔✔A face-to face meeting between a covered person and a health-care
provider in which services are provided.
✔✔End Stage Renal Disease - ✔✔a term used to describe a kidney impairment that
appears irreversible and permanent and requires a regular course of dialysis or kidney
transplant to maintain life. Patients receiving care for this disease are eligible for
Medicare, if they meet other requirements and if they apply.
✔✔Enrolled Group - ✔✔Persons with the same employer or with membership in an
organization in common, who are enrolled collectively in a health plan. Often, there are
stipulations regarding the minimum size of the group and the minimum percentage of
the group that must enroll before coverage is available.
, ✔✔Enrollee - ✔✔Any person eligible as either a subscriber or a dependent for service
in accordance with a contract. Also refers to a member in a database. (Also, beneficiary;
individual; member)
✔✔Episode - ✔✔Also known as a visit or an encounter with the health system. The visit
is initiated by a request for service.
✔✔Evidence of Coverage (EOC) - ✔✔An addendum of the group plan contract and
constitutes only a summary of the terms and conditions of coverage.If there is a conflict
between the ______ and the group plan contract, the group plan contract will prevail.
✔✔Exclusions - ✔✔Specific conditions or circumstances listed in the contract or
employee benefit plan for which the policy or plan will not provide benefit payments.
✔✔Exhaustion of Benefits - ✔✔The maximum contract amount payable by the
insurance carrier for services. Many payers have a calendar year and a lifetime
maximum limit on benefits they will pay for. There are no more funds available for
coverage of any further services.
✔✔Explanation of Benefits - ✔✔The statement sent to a covered person by a health
plan, listing services provided, benefits paid on the claim, deductible and/or co-payment
amounts, and any remaining balance due. Denote the amount of the member's liability.
✔✔FAQ - ✔✔Frequently Asked Question(s)
✔✔Fee Schedule - ✔✔A listing of accepted fees or established allowances for specified
medical procedures. As used in medical care plans, it usually represents the maximum
amounts the program will pay for the specified procedures. Usually associated with
ancillary services such as lab or radiology.
✔✔Fee-for-Service - ✔✔The traditional healthcare payment system, under which
physicians and other providers receive a payment for each unit of service provided.
✔✔Financial Class - ✔✔A code that identifies the primary insurance for an account.
Related to insurance plan codes.
✔✔Financial Counseling - ✔✔Could also be called "financial investigation," as it is the
method through which the provider identifies actual payment sources and alternatives.
Must review every uninsured or under-insured patient to determine a valid source of
payment in order to minimize uncollectables. This should be seen as a patient support
service, not a collection agency.
✔✔Fiscal Intermediary - ✔✔Generally refers to an organization contracted with the
Health Care Financing Administration (HCFA) Centers for Medicare and Medicaid
Services (CMS) to process and pay Medicare UB-04 claims.
AND SOLUTIONS RATED A+
✔✔Diagnosis Related Group (DRG) - ✔✔System for classification for over 490
diagnoses based on patterns in resource consumption and length of stay. Used in many
prospective payment plans including Medicare. Classify all human diseases according
to the affected organ system, surgical procedures performed, disposition and gender of
the patient. Currently, there are over 500 active _______ within the inpatient
prospective pricing methodology. A flat rate is paid per inpatient stay based on the
assigned _______ .
✔✔Discharge Planning - ✔✔Medical personnel of the health plan work with the
attending physician and hospital staff to assess alternatives to hospitalization, evaluate
appropriate settings for care and arrange for discharge of a patient, including planning
for subsequent care at home or in a skilled nursing facility.
✔✔Discounted Fee-for-Service - ✔✔An agreed-upon rate for service between the
provider and payer that is usually less than the provider's full fee. This may be a fixed
amount per service, or a percentage discount.
✔✔Donor - ✔✔One from whom blood, tissue or an organ is taken for use in a
transfusion or transplant.
✔✔Durable Medical Equipment (DME) - ✔✔Typically withstands repeated use,
improves function or retards further deterioration of a physical condition, and primarily
provides a medical function. (Ex: Hospital bed; wheelchair)
✔✔Durable Power of Attorney for Healthcare - ✔✔A legally assigned individual that is
empowered to make medical treatment decisions on the patient's behalf if the patient is
incapacitated and cannot speak for them self. Also known as a Healthcare Agent or
Proxy.
✔✔Effective Dates Insurance - ✔✔The beginning and ending dates for which third-party
financial responsibility is enforced. Any service dates before or after these dates will not
be covered by a particular third party.
✔✔Electronic Media - ✔✔The storage and transmission tools used to store and deliver
information or data and utilizes electronics or electromechanical energy for the end user
to access the content.
✔✔Eligibility - ✔✔The act of confirming a person's status with the employer or union. A
person who is entitled to benefits according to an employer or union, and is currently
covered by insurance.
,✔✔Eligible Dependent - ✔✔A dependent of a covered employee who meets the
requirements specified in the group contract to qualify for coverage and for whom
premium payment is made.
✔✔Eligible Expenses - ✔✔Reasonable and customary charges, or the agreed upon fee
for health services and supplies covered under a health plan.
✔✔Email - ✔✔a telecommunications system that enables users to send messages
prepared on a computer to another computer user. Telephone lines are generally used
to send the signal from terminal to terminal. Files may be sent via _______ but the
recipient must have compatible software to open them.
✔✔Emancipation - ✔✔Legal term that means a child is no longer under the control of
the parent. The definition varies from state to state.meaning they have been released
from their parents' control and supervision and are responsible for themselves. _______
minors are their own guarantors.
✔✔Emergency Care Patient - ✔✔Patients examined on an unscheduled basis for
immediate diagnosis and treatment in the emergency facilities of the hospital. They are
not admitted for inpatient service. An individual who receives immediate medical
attention through the Emergency department.
✔✔Emergency Medical Treatment and Active Labor Act (EMTALA) - ✔✔A statute that
governs when and how a patient may be (1) refused treatment or (2) transferred from
one hospital to another when they are in an unstable medical condition. Also known as
the anti-dumping law.
✔✔Employer Group Health Plan (EGHP) - ✔✔Health insurance provided through an
employer.
✔✔Encounter - ✔✔A face-to face meeting between a covered person and a health-care
provider in which services are provided.
✔✔End Stage Renal Disease - ✔✔a term used to describe a kidney impairment that
appears irreversible and permanent and requires a regular course of dialysis or kidney
transplant to maintain life. Patients receiving care for this disease are eligible for
Medicare, if they meet other requirements and if they apply.
✔✔Enrolled Group - ✔✔Persons with the same employer or with membership in an
organization in common, who are enrolled collectively in a health plan. Often, there are
stipulations regarding the minimum size of the group and the minimum percentage of
the group that must enroll before coverage is available.
, ✔✔Enrollee - ✔✔Any person eligible as either a subscriber or a dependent for service
in accordance with a contract. Also refers to a member in a database. (Also, beneficiary;
individual; member)
✔✔Episode - ✔✔Also known as a visit or an encounter with the health system. The visit
is initiated by a request for service.
✔✔Evidence of Coverage (EOC) - ✔✔An addendum of the group plan contract and
constitutes only a summary of the terms and conditions of coverage.If there is a conflict
between the ______ and the group plan contract, the group plan contract will prevail.
✔✔Exclusions - ✔✔Specific conditions or circumstances listed in the contract or
employee benefit plan for which the policy or plan will not provide benefit payments.
✔✔Exhaustion of Benefits - ✔✔The maximum contract amount payable by the
insurance carrier for services. Many payers have a calendar year and a lifetime
maximum limit on benefits they will pay for. There are no more funds available for
coverage of any further services.
✔✔Explanation of Benefits - ✔✔The statement sent to a covered person by a health
plan, listing services provided, benefits paid on the claim, deductible and/or co-payment
amounts, and any remaining balance due. Denote the amount of the member's liability.
✔✔FAQ - ✔✔Frequently Asked Question(s)
✔✔Fee Schedule - ✔✔A listing of accepted fees or established allowances for specified
medical procedures. As used in medical care plans, it usually represents the maximum
amounts the program will pay for the specified procedures. Usually associated with
ancillary services such as lab or radiology.
✔✔Fee-for-Service - ✔✔The traditional healthcare payment system, under which
physicians and other providers receive a payment for each unit of service provided.
✔✔Financial Class - ✔✔A code that identifies the primary insurance for an account.
Related to insurance plan codes.
✔✔Financial Counseling - ✔✔Could also be called "financial investigation," as it is the
method through which the provider identifies actual payment sources and alternatives.
Must review every uninsured or under-insured patient to determine a valid source of
payment in order to minimize uncollectables. This should be seen as a patient support
service, not a collection agency.
✔✔Fiscal Intermediary - ✔✔Generally refers to an organization contracted with the
Health Care Financing Administration (HCFA) Centers for Medicare and Medicaid
Services (CMS) to process and pay Medicare UB-04 claims.
