NUR 425 Exam 3 Questions with 100% Correct Answers | Verified | Updated
(Actual Exam) LATEST VERSION!!
3 Primary Sources that Pay for Healthcare - (ANSWER)Government (Medicare & Medicaid), private
health insurance (through your job), and out-of-pocket (includes deductibles, copayments, and anything
paid by the individual)
Medicare Part A - (ANSWER)Federal program that is the insurance plan for hospital, hospice, home
health, and skilled nursing care paid through with social security taxes. Nursing home care is NOT
covered.
Medicaid - (ANSWER)State level programs funded by state and federal. Pays for services for the blind,
disabled, medically indigent, children with disabilities and covers a lot.
Cost-Based System - (ANSWER)Consists of the cost of providing a service plus an additional cost for
profit. Third party payers costs decided by surveying a certain area, and payment is selected after the
service is provided.
Contractual Allowance - (ANSWER)Given when reimbursed amount is less than the full charge of service
in a cost-based system because it is similar to a "discount" for the third party payer.
Prospective Payment System - (ANSWER)Third-party payer decides what and how much will be paid for a
service. If the cost of care is higher than the payment, the provider absorbs the loss. Profit is made when
the cost of care is lower.
Diagnosis Related Groups - (ANSWER)Basis of payment in the Prospective Payment System which groups
people based on their diagnosis on their average hospital stay, lab costs, surgeries, therapies, etc. Does
not accurately reflect patient intensity or acuity. PPS with DRG caused increased patient acuity and
decreased length of stay in hospitals
Value Based Purchasing/Pay-for-Performance - (ANSWER)Reimbursed based on performance and
outcomes versus rather than considering the cost of providing certain care. Based on quality outcomes,
staff responsiveness, cleanliness, quietness of hospital environment
, NUR 425 Exam 3 Questions with 100% Correct Answers | Verified | Updated
(Actual Exam) LATEST VERSION!!
Capitation - (ANSWER)Form of Prospective Based Payment. It is a Decided amount of what will be paid
per patient per days, not based on the procedure. There is a profit when the stay is shorter for patients.
Nurse's Role in Capitation - (ANSWER)Nurse must strive to do more in a visit to prevent return visits and
complications as they are working on only a set amount of days that is being paid for. They need to
complete care under the set amount of paid days for the company to make a profit
Nurse's Role with Case Management - (ANSWER)Knowledge of patient goals and anticipated discharge
date. Appropriate and timely interventions when the patient isn't progressing as expected. Ongoing
patient and family education. Identifying barriers to discharge.
Operating Budget Defined - (ANSWER)Financial plan generated from daily operations which takes into
account a day's personnel, supply, expenses, and revenue. THE EXPENSE PORTION is the most time
consuming. More specifically, personnel is determined with unit of service
Unit of Service - (ANSWER)Essentially, it is personnel on the unit. Contains nurse to bed ratios, acuity,
and type of staff (RNs, LPNs). Predicts the volume of work required, and the personnel budget is
established from there
Full-Time Equivalents (FTEs) - (ANSWER)Used when determining personnel budgets and simplifying who
works full-time and part-time but not considering their roles. Full time equivalents are 2,080 paid hours
per year which can be productive and nonproductive
Productive vs. Nonproductive Hours - (ANSWER)Productive= paid time that is worked
Nonproductive=paid time that is not worked (PTO, vacation, orientation, sick time)
Capital Expenditure Budget - (ANSWER)reflects expenses related to the purchase of major capital items
such as equipment and physical plant. The capital expenditure must have a useful life of more than one
year (usually 1-5 years) and must exceed the organization's cost. Kept separate from the operating
budget because the high cost would be reflected in the cost of patient care, also showing way too high
(Actual Exam) LATEST VERSION!!
3 Primary Sources that Pay for Healthcare - (ANSWER)Government (Medicare & Medicaid), private
health insurance (through your job), and out-of-pocket (includes deductibles, copayments, and anything
paid by the individual)
Medicare Part A - (ANSWER)Federal program that is the insurance plan for hospital, hospice, home
health, and skilled nursing care paid through with social security taxes. Nursing home care is NOT
covered.
Medicaid - (ANSWER)State level programs funded by state and federal. Pays for services for the blind,
disabled, medically indigent, children with disabilities and covers a lot.
Cost-Based System - (ANSWER)Consists of the cost of providing a service plus an additional cost for
profit. Third party payers costs decided by surveying a certain area, and payment is selected after the
service is provided.
Contractual Allowance - (ANSWER)Given when reimbursed amount is less than the full charge of service
in a cost-based system because it is similar to a "discount" for the third party payer.
Prospective Payment System - (ANSWER)Third-party payer decides what and how much will be paid for a
service. If the cost of care is higher than the payment, the provider absorbs the loss. Profit is made when
the cost of care is lower.
Diagnosis Related Groups - (ANSWER)Basis of payment in the Prospective Payment System which groups
people based on their diagnosis on their average hospital stay, lab costs, surgeries, therapies, etc. Does
not accurately reflect patient intensity or acuity. PPS with DRG caused increased patient acuity and
decreased length of stay in hospitals
Value Based Purchasing/Pay-for-Performance - (ANSWER)Reimbursed based on performance and
outcomes versus rather than considering the cost of providing certain care. Based on quality outcomes,
staff responsiveness, cleanliness, quietness of hospital environment
, NUR 425 Exam 3 Questions with 100% Correct Answers | Verified | Updated
(Actual Exam) LATEST VERSION!!
Capitation - (ANSWER)Form of Prospective Based Payment. It is a Decided amount of what will be paid
per patient per days, not based on the procedure. There is a profit when the stay is shorter for patients.
Nurse's Role in Capitation - (ANSWER)Nurse must strive to do more in a visit to prevent return visits and
complications as they are working on only a set amount of days that is being paid for. They need to
complete care under the set amount of paid days for the company to make a profit
Nurse's Role with Case Management - (ANSWER)Knowledge of patient goals and anticipated discharge
date. Appropriate and timely interventions when the patient isn't progressing as expected. Ongoing
patient and family education. Identifying barriers to discharge.
Operating Budget Defined - (ANSWER)Financial plan generated from daily operations which takes into
account a day's personnel, supply, expenses, and revenue. THE EXPENSE PORTION is the most time
consuming. More specifically, personnel is determined with unit of service
Unit of Service - (ANSWER)Essentially, it is personnel on the unit. Contains nurse to bed ratios, acuity,
and type of staff (RNs, LPNs). Predicts the volume of work required, and the personnel budget is
established from there
Full-Time Equivalents (FTEs) - (ANSWER)Used when determining personnel budgets and simplifying who
works full-time and part-time but not considering their roles. Full time equivalents are 2,080 paid hours
per year which can be productive and nonproductive
Productive vs. Nonproductive Hours - (ANSWER)Productive= paid time that is worked
Nonproductive=paid time that is not worked (PTO, vacation, orientation, sick time)
Capital Expenditure Budget - (ANSWER)reflects expenses related to the purchase of major capital items
such as equipment and physical plant. The capital expenditure must have a useful life of more than one
year (usually 1-5 years) and must exceed the organization's cost. Kept separate from the operating
budget because the high cost would be reflected in the cost of patient care, also showing way too high
