CNML Test Exam Questions And 100%
Correct Answers
DRGs - ANSWER Diagnostic-Related Groups: payment rate is based on specific
diagnoses
Prospective Payment System - ANSWER Used by Medicare-participating hospitals:
pretreatment diagnosis billings based on DRGs; rate is pre-determined between
insurance companies and hospitals
Exclusive Provider - ANSWER Used by HMO's: coverage for insured patients only with
contracted providers or institutions
HMOs - ANSWER Health maintenance organizations: comprehensive health care to
individuals who pay a fee for a specific period of time
Capitation- 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- ANSWER Preferred provider organizations: special reduced rate for services
when customers use certain providers approved by the insurance company; usually
fee-for-service
IPAs-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- ANSWER 2080 hours (1.0 @ 40 hours per week)
Capital Expenses- 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 - ANSWER Each new budget, or beginning fiscal year, it is
determined which programs/areas receive funding. This does not consider any type of
historical perspective; this may also rank packages and then fund only the top-ranked. It
can be a very time-consuming way of developing a budget.
Variance Calculation & Reminders - 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 - ANSWER Nurse Time X (Avg. RN Hourly Rate +
Benefits + Indirects) = Total Nursing Cost per DRG
General Nurse Staffing Calculation - ANSWER # of RNs needed X days open / # days
worked per RN
FTE Definition & Calculation - ANSWER Full-time equivalent = full-time employee paid for
1 year
FTE = (Hours per shift X # of days worked) / 40 hours
Fixed Costs - ANSWER Stay the same no matter the census: manager salaries, keeping
phones on, rent, etc.
Variable Costs - ANSWER Change with census and how much staffing is used
Net Revenue Calculation - ANSWER Gross Revenue - Deductions from Revenue (DRGs
and the Contractual allowances paid by insurance companies)
UAP - ANSWER Unlicensed assistive personnel (CNA's)
, ADC - ANSWER Average daily census (patients in a bed at midnight)
Total Patient Days Calculation - ANSWER ADC X Days open per year (for SCH - ADC X
365)
Calculation of Nurse Hours Per Patient Day (HPPD) - ANSWER Total Direct Care Hours /
Total Patient Days = # of RN hours needed to provide care for a pt. for 24 hours.
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-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 -ANSWER Negotiated pay for services by insurance companies
regardless of what services were actually completed; per day admitted
UOS - ANSWER Unit of service: patient days for inpatient nursing but could be visits or #
of procedures or whatever that healthcare organization counts
RVU - 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 - ANSWER Average length of stay = # of pt. days / # of discharges (in
same time period)
CPUOS - ANSWER Cost per unit of service = salaries / UOS
Productivity - ANSWER # of staff hours or s / # of UOS
Correct Answers
DRGs - ANSWER Diagnostic-Related Groups: payment rate is based on specific
diagnoses
Prospective Payment System - ANSWER Used by Medicare-participating hospitals:
pretreatment diagnosis billings based on DRGs; rate is pre-determined between
insurance companies and hospitals
Exclusive Provider - ANSWER Used by HMO's: coverage for insured patients only with
contracted providers or institutions
HMOs - ANSWER Health maintenance organizations: comprehensive health care to
individuals who pay a fee for a specific period of time
Capitation- 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- ANSWER Preferred provider organizations: special reduced rate for services
when customers use certain providers approved by the insurance company; usually
fee-for-service
IPAs-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- ANSWER 2080 hours (1.0 @ 40 hours per week)
Capital Expenses- 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 - ANSWER Each new budget, or beginning fiscal year, it is
determined which programs/areas receive funding. This does not consider any type of
historical perspective; this may also rank packages and then fund only the top-ranked. It
can be a very time-consuming way of developing a budget.
Variance Calculation & Reminders - 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 - ANSWER Nurse Time X (Avg. RN Hourly Rate +
Benefits + Indirects) = Total Nursing Cost per DRG
General Nurse Staffing Calculation - ANSWER # of RNs needed X days open / # days
worked per RN
FTE Definition & Calculation - ANSWER Full-time equivalent = full-time employee paid for
1 year
FTE = (Hours per shift X # of days worked) / 40 hours
Fixed Costs - ANSWER Stay the same no matter the census: manager salaries, keeping
phones on, rent, etc.
Variable Costs - ANSWER Change with census and how much staffing is used
Net Revenue Calculation - ANSWER Gross Revenue - Deductions from Revenue (DRGs
and the Contractual allowances paid by insurance companies)
UAP - ANSWER Unlicensed assistive personnel (CNA's)
, ADC - ANSWER Average daily census (patients in a bed at midnight)
Total Patient Days Calculation - ANSWER ADC X Days open per year (for SCH - ADC X
365)
Calculation of Nurse Hours Per Patient Day (HPPD) - ANSWER Total Direct Care Hours /
Total Patient Days = # of RN hours needed to provide care for a pt. for 24 hours.
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-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 -ANSWER Negotiated pay for services by insurance companies
regardless of what services were actually completed; per day admitted
UOS - ANSWER Unit of service: patient days for inpatient nursing but could be visits or #
of procedures or whatever that healthcare organization counts
RVU - 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 - ANSWER Average length of stay = # of pt. days / # of discharges (in
same time period)
CPUOS - ANSWER Cost per unit of service = salaries / UOS
Productivity - ANSWER # of staff hours or s / # of UOS
