CNML Test Questions And Answers Latest Top Score.

CNML Test Questions And Answers Latest Top Score. DRGs - correct answer. Diagnostic-Related Groups: payment rate based on specific diagnoses Prospective Payment System - correct answer. Used by Medicare-participating hospitals: pretreatment diagnosis billings based on DRGs; rate decided ahead of time between insurance companies and hospitals Exclusive Provider - correct answer. Used by HMO's: insurance coverage for contracted providers or institutions HMOs - correct answer. Health maintenance organizations: comprehensive healthcare to people who pay a fee for a fixed period of time Capitation - correct answer. Fixed rate paid to provider per member per month for healthcare services; set fee paid by insurance company per month for all the patient needs PPOs - correct answer. Preferred provider organizations: special reduced rate for services when customers use certain providers approved by the insurance company; usually fee-for-service IPAs - correct answer. Individual provider arrangements: provide care in their offices for prepaid plans; coalition of physicians who serve HMO patients and third-party patients Fulltime FTE Hours - correct answer. 2080 hours (1.0 @ 40 hours per week) Capital Expenses - correct answer. Long-term equipment or physical purchases: usually over $500-$1000 that will last years and depreciate over time and be used multiple times Zero-Based Budget - correct answer. With each new budget (i.e. fiscal year), it is determined which programs/areas get money; no historical context is used; may rank packages and then only fund top-ranked ones; can be time-consuming way to create a budget Variance Calculation & Reminders - correct answer. Variance $ /Budgeted $ X 100 = % difference; contract staff on separate line of budget; many staff sick costs more than a few staff on LOA Cost of Nursing Services Calculation - correct answer. Nurse Time X (Avg. RN Hourly Rate + Benefits + Indirects) = Total Nursing Cost per DRG General Nurse Staffing Calculation - correct answer. # of RNs needed X days open / # days worked per RN FTE Definition & Calculation - correct answer. Full-time equivalent = full-time employee paid for 1 year FTE = (Hours per shift X # of days worked) / 40 hours Fixed Costs - correct answer. Stay the same no matter the census: manager salaries, keeping phones on, rent, etc. Variable Costs - correct answer. Change with census and how much staffing is used Net Revenue Calculation - correct answer. Gross Revenue - Deductions from Revenue (DRGs and the Contractual allowances paid by insurance companies) UAP - correct answer. Unlicensed assistive personnel (CNA's) ADC - correct answer. Average daily census (patients in a bed at midnight) Total Patient Days Calculation - correct answer. ADC X Days open per year (for SCH - ADC X 365) Nurse Hours Per Patient Day (HPPD) Calculation - correct answer. Total Direct Care Hours / Total Patient Days = # of RN hours needed to provide care for a pt. for 24 hours. For example - for 12 hour staff and 12 workers each shift you multiply 12 staff X 2 shifts = 24 staff X 12 hours each = 288 divided by midnight census of 31 = NHPPD VBP - correct answer. Value-based purchasing: how CMS determines how much to reimburse a hospital for care (benchmarked standards and how they are meeting it); quality of care & following best practice & patient experience Per Diem Rate - correct answer. Negotiated pay for services by insurance companies regardless of what services were actually completed; per day admitted UOS - correct answer. Unit of service: patient days for inpatient nursing but could be visits or # of procedures or whatever that healthcare organization counts RVU - correct answer. Relative value unit: what ancillary services might use to add up their UOS; # of hi-flows hooked up or vents started for RT., for example ALOS Calculation - correct answer. Average length of stay = # of pt. days / # of discharges (in same time period) CPUOS - correct answer. Cost per unit of service = salaries / UOS Productivity - correct answer. # of staff hours or $'s / # of UOS RN hours / patients in beds @ midnight (HOC) RN salaries / UOS Output / input Amount of work performed by a set # of staff Minimum Staffing - correct answer. Minimum staff needed to operate unit usually determined by law, hospital policy, and pt safety Breakeven - correct answer. Needed in order not to lose money; minimum patients needed to meet budget using minimum staffing; can't control admissions but some would work with staffing office to ensure minimum occupancy occurred Medicare - correct answer. Federal program that helps those over 65, those on dialysis/ESRD, and combines with state run Medicaid, younger people who are permanently disabled, and physician residency training EMTALA - correct answer. Emergency Medical Treatment and Active Labor Act: must treat people in ED regardless of ability to pay, citizenship, and legal status Case Mix Index - correct answer. A system that classifies patients by age, diagnosis, treatment, clinical, and financial categories to develop the reimbursement rate Productive Time - correct answer. 2080 hours - Benefit hours Revenue - correct answer. Gross = $ charged Net = $ collected OE for Budgets - correct answer. Operating Expenses: salaries, supplies, rent, non-productive time, etc. Margin - correct answer. Difference between expenses and how much money is collected Margins down = less gross or net income Margins up = more gross or net income Workload Per Day - correct answer. Total workload hours / 365 days / 24 hours Costs in a Budget - correct answer. Fixed, variable & non-recurring (like installing new piece of equipment or 100th anniversary party for the hospital) Replacement Factor - correct answer. Adding up the benefit time because nurses don't actually work 2080 hours per year; add this to the total FTE's HCAHPS - correct answer. Hospital Consumer Assessment of Healthcare Providers and Systems: national survey asking patients how their stay was National Labor Relations Act (NLRA) - correct answer. (AKA: Wagner Act) Passed to end the depression; prevented employers from cutting wages; lots of power to unions/employees; 1974 amendments created union needs to give notice before striking, no strikes during notice time, written notice to employers about new contract need, mediation needs, board of inquiry to settle disputes, and allowed employees to bow out of joining; created unfair labor practices against employers from stopping unions or discriminating against union employees Rights of unions/workers Labor Management Relations Act - correct answer. (AKA: Taft-Hartley Act) Listed union restrictions to even out rights between employees and employers from the NLRA/Wagner Act; placed restrictions on labor organizations like forcing employees to join or refusing to bargain; created code of contact for unions Rights of management Civil Rights Act of 1964 - correct answer. Prohibits discrimination against race, religion, sex, creed, color, gender, national origin Recognition Phase of Negotiations - correct answer. Need 30% of nurses to sign individualized authorization cards before labor union can rep them