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CHAM 2025/2026 – 170+ Verified Exam Questions & Answers | Medicare, HIPAA, Coding, Billing, Payers, Compliance & Utilization Review

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This expertly compiled CHAM (Certified Healthcare Access Manager) 2025/2026 exam preparation guide contains over 170 verified questions and answers, aligned with the latest industry standards and best practices. Each item is presented in a Q&A format with clear, concise definitions and explanations, making it an essential tool for mastering the CHAM credential. This document is designed to ensure complete coverage of the National Association of Healthcare Access Management (NAHAM) exam topics. Topics include: Insurance and Reimbursement Systems: Fee-for-Service, Capitation, PPO, HMO, POS, Indemnity, Medigap, COBRA, Managed Care Government Programs: Medicare Parts A & B, TRICARE, Medicaid, CMS, DRGs, PPS, Medicare Secondary Payer (MSP) Healthcare Compliance: HIPAA, OIG, OBRA, No Balance Billing, CCI, Compliance Forms (HCFA 1500, UB-04) Medical Billing & Coding: CPT, ICD, HCPCS, Relative Value Scale, DRG, Form Locators, Occurrence Codes Utilization Management: Pre-authorization, Utilization Review, Clinical Integration, Outlier Identification Patient Access & Financial Responsibility: Co-pays, Deductibles, Co-insurance, Stop Loss, A/R Calculation Healthcare Roles & Settings: Nurse Practitioners, Emergency Services, Critical Access Hospitals, Inpatient vs Outpatient Designations Data & Quality Management: Descriptive vs Inferential Statistics, CDR, Benchmarking, QIO, Patient Rights Disaster Planning & Administration: Hotwashes, SCA, Training Effectiveness, Credentialing, Recidivism Rates This document is valuable for: CHAM candidates preparing for NAHAM certification Healthcare administration students (AAS, BHA, MHA) Patient access managers and coordinators Revenue cycle professionals and compliance officers Medical billing, insurance verification, and utilization review specialists Every term and acronym—like HIPAA, COBRA, CPT, PPS, QIO, and more—is covered in a manner that builds real-world understanding. Rated A+, this document is your key to passing the CHAM exam with confidence and advancing your career in healthcare access leadership. Keywords: CHAM exam, NAHAM, healthcare access management, patient access, revenue cycle, HIPAA compliance, Medicare billing, Medicaid, CPT codes, HCPCS, UB-04, CMS 1500, insurance plans, managed care, utilization review, co-pay, deductible, statistics in healthcare, coding compliance, DRG, PPS, A/R management, healthcare compliance, insurance verification, clinical integration

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Institution
CHAM Certified Healthcare Access Manager
Course
CHAM Certified Healthcare Access Manager

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Uploaded on
August 3, 2025
Number of pages
14
Written in
2025/2026
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CHAM 2025/2026 Exam Questions and
Answers 100% Guaranteed Success |
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Indemnity - 🧠 ANSWER ✔✔Health ins plan in which pts may select dr or hosp

and providers bill the pt or their ins their normal fees for svc. coverage is usually

provided for diag test or cond caused by disease, illness, or injury. Routine

screening and well vts are not always covered, also known as "fee-for-service".


Joint Commission - 🧠 ANSWER ✔✔Which organization evaluates the policies,

procedures, and outcomes of care provided by hospitals?

This organization has been responsible for accrediting healthcare organizations

since the middle 1950s and determines whether the organization is continually

monitoring and improving the quality of care they provide.

, Inpatient - 🧠 ANSWER ✔✔term used when a patient is admitted to the hospital w/

the expectation that the pt will stay for a period of 24 hrs or more


Medical Record Number - 🧠 ANSWER ✔✔Unique number associated with your

name in the medical record

MRN


No Balance Billing Provision - 🧠 ANSWER ✔✔provider contract clause which

states the provider agrees to accept the amount the plan pays as payment in full not

to bill the members/(except co-pays, coinsurand deductables)


Correct Coding Initiative - 🧠 ANSWER ✔✔federal legislation that attempts to

eliminate unbundling or other inappropriate reporting of procedural codes for

professional medical services rendered to patients

CCI, Federal legislation that attempts to eliminate unbundling or other

inappropriate reporting of procedural codes for professional medical services

rendered to patients


Medigap Insurance - 🧠 ANSWER ✔✔To pay for medical services and items that

Medicare does not cover and Medicare's coinsurance and deductibles, beneficiaries

may purchase a supplemental insurance. Private insurance designed to help pay for

those amounts that are typically the patient;s responsibility under Medicare.

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