CNML TEST EXAM SET |GUARANTEED
PASS |VERIFIED!!
DRGs - ACCURATE ANSWERS✔✔ Diagnostic-Related Groups:
payment rate based on specific diagnoses.
Prospective Payment System - ACCURATE ANSWERS✔✔ Used by
Medicare-participating hospitals: pretreatment diagnosis billings based
on DRGs; rate decided ahead of time between insurance companies and
hospitals.
Exclusive Provider - ACCURATE ANSWERS✔✔ Used by HMO's:
insurance coverage for contracted providers or institutions
HMOs - ACCURATE ANSWERS✔✔ Health maintenance
organizations: comprehensive healthcare to people who pay a fee for a
fixed period of time
Capitation - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ Preferred provider organizations:
special reduced rate for services when customers use certain providers
approved by the insurance company; usually fee-for-service
,IPAs - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ 2080 hours (1.0 @
40 hours per week)
Capital Expenses - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔
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 - ACCURATE ANSWERS✔✔
Nurse Time X (Avg. RN Hourly Rate + Benefits + Indirects) = Total
Nursing Cost per DRG
,General Nurse Staffing Calculation - ACCURATE ANSWERS✔✔ # of
RNs needed X days open / # days worked per RN
FTE Definition & Calculation - ACCURATE ANSWERS✔✔ Full-time
equivalent = full-time employee paid for 1 year
FTE = (Hours per shift X # of days worked) / 40 hours
Fixed Costs - ACCURATE ANSWERS✔✔ Stay the same no matter the
census: manager salaries, keeping phones on, rent, etc.
Variable Costs - ACCURATE ANSWERS✔✔ Change with census and
how much staffing is used
Net Revenue Calculation - ACCURATE ANSWERS✔✔ Gross Revenue
- Deductions from Revenue (DRGs and the Contractual allowances paid
by insurance companies)
UAP - ACCURATE ANSWERS✔✔ Unlicensed assistive personnel
(CNA's)
ADC - ACCURATE ANSWERS✔✔ Average daily census (patients in a
bed at midnight)
, Total Patient Days Calculation - ACCURATE ANSWERS✔✔ ADC X
Days open per year (for SCH - ADC X 365)
Nurse Hours Per Patient Day (HPPD) Calculation - ACCURATE
ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ Negotiated pay for
services by insurance companies regardless of what services were
actually completed; per day admitted
UOS - ACCURATE ANSWERS✔✔ Unit of service: patient days for
inpatient nursing but could be visits or # of procedures or whatever that
healthcare organization counts
PASS |VERIFIED!!
DRGs - ACCURATE ANSWERS✔✔ Diagnostic-Related Groups:
payment rate based on specific diagnoses.
Prospective Payment System - ACCURATE ANSWERS✔✔ Used by
Medicare-participating hospitals: pretreatment diagnosis billings based
on DRGs; rate decided ahead of time between insurance companies and
hospitals.
Exclusive Provider - ACCURATE ANSWERS✔✔ Used by HMO's:
insurance coverage for contracted providers or institutions
HMOs - ACCURATE ANSWERS✔✔ Health maintenance
organizations: comprehensive healthcare to people who pay a fee for a
fixed period of time
Capitation - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ Preferred provider organizations:
special reduced rate for services when customers use certain providers
approved by the insurance company; usually fee-for-service
,IPAs - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ 2080 hours (1.0 @
40 hours per week)
Capital Expenses - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔
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 - ACCURATE ANSWERS✔✔
Nurse Time X (Avg. RN Hourly Rate + Benefits + Indirects) = Total
Nursing Cost per DRG
,General Nurse Staffing Calculation - ACCURATE ANSWERS✔✔ # of
RNs needed X days open / # days worked per RN
FTE Definition & Calculation - ACCURATE ANSWERS✔✔ Full-time
equivalent = full-time employee paid for 1 year
FTE = (Hours per shift X # of days worked) / 40 hours
Fixed Costs - ACCURATE ANSWERS✔✔ Stay the same no matter the
census: manager salaries, keeping phones on, rent, etc.
Variable Costs - ACCURATE ANSWERS✔✔ Change with census and
how much staffing is used
Net Revenue Calculation - ACCURATE ANSWERS✔✔ Gross Revenue
- Deductions from Revenue (DRGs and the Contractual allowances paid
by insurance companies)
UAP - ACCURATE ANSWERS✔✔ Unlicensed assistive personnel
(CNA's)
ADC - ACCURATE ANSWERS✔✔ Average daily census (patients in a
bed at midnight)
, Total Patient Days Calculation - ACCURATE ANSWERS✔✔ ADC X
Days open per year (for SCH - ADC X 365)
Nurse Hours Per Patient Day (HPPD) Calculation - ACCURATE
ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ 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 - ACCURATE ANSWERS✔✔ Negotiated pay for
services by insurance companies regardless of what services were
actually completed; per day admitted
UOS - ACCURATE ANSWERS✔✔ Unit of service: patient days for
inpatient nursing but could be visits or # of procedures or whatever that
healthcare organization counts
