CHAM LATEST EXAM TEST 2026/2027 QUESTIONS AND
SOLUTIONS RATED A+
✔✔Impatient - ✔✔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.
✔✔Insurance Verification - ✔✔The process of determining coverage availability and
benefits of coverage.
✔✔Insured - ✔✔The individual who is the holder of healthcare coverage through an
insurance policy.
✔✔Insurer - ✔✔A health insurance plan or another entity that processes and pays
healthcare bills
✔✔Interface - ✔✔A program that passes information from one system to another.
✔✔Intermediary - ✔✔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.
✔✔Internet - ✔✔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.
✔✔Itemized Statement - ✔✔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.
✔✔Joint Commission on Accreditation of Healthcare Organizations (JCAHO) - ✔✔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.
✔✔Length of Stay (LOS) - ✔✔The total number of patient days for an inpatient episode,
calculated by subtracting the date of admission from the date of discharge
, ✔✔Liability Insurance - ✔✔insurance that pays for bodily injury and property damage. It
includes, but is not limited to, automobile insurance, uninsured motorist insurance,
malpractice insurance.
✔✔Lifetime Maximum - ✔✔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.
✔✔Lifetime Reserve Days (LRD) - ✔✔the term for Medicare Part A coverage that
entitles the beneficiary to 60 days of inpatient coverage beyond the coinsurance day
benefit period.
✔✔Long Term Care - ✔✔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.
✔✔Managed 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.
✔✔Managed Care Organization - ✔✔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 insurer's or administrator's
clients.
✔✔Managed Healthcare - ✔✔A system of healthcare delivery that tries to manage the
cost of healthcare, the quality of that healthcare and access to that care.
✔✔Master Patient Index (MPI) - ✔✔a comprehensive list of all patients and their key
identifiers.
✔✔Medicaid - ✔✔A joint Federal and State program that is administered and operated
individually by each participating state government. Provides medical benefits to some
people with low-income and limited resources. Since the state government administers
it, regulations and benefits vary from state to state. Each state may adopt a different
name for the program.
✔✔Medical Record - ✔✔a clinical record of the services, results of tests and progress
notes associated with a patient visit.
SOLUTIONS RATED A+
✔✔Impatient - ✔✔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.
✔✔Insurance Verification - ✔✔The process of determining coverage availability and
benefits of coverage.
✔✔Insured - ✔✔The individual who is the holder of healthcare coverage through an
insurance policy.
✔✔Insurer - ✔✔A health insurance plan or another entity that processes and pays
healthcare bills
✔✔Interface - ✔✔A program that passes information from one system to another.
✔✔Intermediary - ✔✔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.
✔✔Internet - ✔✔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.
✔✔Itemized Statement - ✔✔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.
✔✔Joint Commission on Accreditation of Healthcare Organizations (JCAHO) - ✔✔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.
✔✔Length of Stay (LOS) - ✔✔The total number of patient days for an inpatient episode,
calculated by subtracting the date of admission from the date of discharge
, ✔✔Liability Insurance - ✔✔insurance that pays for bodily injury and property damage. It
includes, but is not limited to, automobile insurance, uninsured motorist insurance,
malpractice insurance.
✔✔Lifetime Maximum - ✔✔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.
✔✔Lifetime Reserve Days (LRD) - ✔✔the term for Medicare Part A coverage that
entitles the beneficiary to 60 days of inpatient coverage beyond the coinsurance day
benefit period.
✔✔Long Term Care - ✔✔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.
✔✔Managed 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.
✔✔Managed Care Organization - ✔✔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 insurer's or administrator's
clients.
✔✔Managed Healthcare - ✔✔A system of healthcare delivery that tries to manage the
cost of healthcare, the quality of that healthcare and access to that care.
✔✔Master Patient Index (MPI) - ✔✔a comprehensive list of all patients and their key
identifiers.
✔✔Medicaid - ✔✔A joint Federal and State program that is administered and operated
individually by each participating state government. Provides medical benefits to some
people with low-income and limited resources. Since the state government administers
it, regulations and benefits vary from state to state. Each state may adopt a different
name for the program.
✔✔Medical Record - ✔✔a clinical record of the services, results of tests and progress
notes associated with a patient visit.
