CNML Exam Review Questions And 100% Correct Answers
Biggest difference between For Profit Organizations vs Not for Profit Organizations -
ANSWER FP Organizations do not follow EMTALA. They can legally discharge a patient
who cannot pay for services. NFP organizations have a responsibility to the community
and must care for ALL conditions regardless of insurance status or ability to pay
For Profit Organizations are owned by. - ANSWER Investors or shareholders
(companies)
Not for Profit organizations do not pay - ANSWER Federal income or state/local property
taxes
Most hospitals in the US are. - ANSWER Not for Profit organizations
Medicare pays for people who. - ANSWER Are 65 and older, are in end stage renal
failure at any age, or have a disability (by prescribed definition) at any age
Four main parts of Medicare - ANSWER Part A, B, C, and D
Medicare Part A - ANS Hospital insurance; pays for inpatient hospital care and some
hospice/home healthcare
Medicare Part B - ANS Medical insurance; pays for doctor's services, outpatient care,
and PT/OT services
Medicare Part C - ANS Medicare Advantage Plan; similar to PPO insurance plan; offers
additional coverage for dental, vision, or wellness; includes parts A & B
,Medicare Part D - ANSWER Prescription drug coverage; open to all but must be covered
under a plan with part D
Medicaid covers. - ANSWER Low-income children, pregnant women, and the elderly
Medicaid pays for. - ANSWER Long term care and mandated health services
Medicaid is funded at the. - ANSWER Federal and state level
Affordable Care Act purpose - ANSWER To make affordable health insurance available
to more people and lower overall healthcare costs
Self-Pay - ANSWER A person or individual who pays for their healthcare services
Charity Pay - ANSWER Healthcare systems receive no reimbursement for services
Health Maintenance Organization HMO Insurance Plans - ANSWER Cost effective care
based on preventative care
PPO Insurance Plans - ANSWER Ability to use in-network physicians at a lower cost;
greater freedom of choice than HMO
DRG Reimbursement - ANSWER Reimbursement to the hospital depends on the average
cost for treating a specific diagnosis using the Prospective Payment System
SHMO Insurance Plans - ANSWER Covers social, health, and medical services that may
be needed
Examples of SHMO covered needs - ANSWER Adult Daycare, Meals, Transportation,
Hospice, Respite Care, etc.
, Pay for Performance (P4P) Reimbursement - ANSWER Hospitals receive financial
incentives to improve the quality of care provided
4 main quality measures for P4P reimbursement - ANSWER Performance, Outcomes,
Patient Satisfaction, and Structures/Technologies (EHR)
Value Based Purchasing - ANSWER Pay for Performance incentive program that gives
incentive payments to acute-care hospitals yearly based on total performance scores
4 major types of budgets for nurse leaders - ANSWER Revenue, Expense, Capital, and
Operating
Revenue Budget - ANSWER Anticipated amount of income during the budget period
Expense budgets are made of what four types of costs? - ANSWER Salary, Non-Salary,
Fixed, and Variable
Fixed costs remain. - ANSWER Constant
Two categories of fixed costs could be. - ANSWER Rental or contract fees
Variable costs can. - ANWER Fluctuate based on unit activity such as census and acuity
Capital Budget - ANWER Equipment and renovation expenses; "think big"
What things need to be considered when considering an item for the capital budget? (4
things) - ANWER Cost of item, installation charges, delivery/shipping charges, and if
there is a need for a service contract
Biggest difference between For Profit Organizations vs Not for Profit Organizations -
ANSWER FP Organizations do not follow EMTALA. They can legally discharge a patient
who cannot pay for services. NFP organizations have a responsibility to the community
and must care for ALL conditions regardless of insurance status or ability to pay
For Profit Organizations are owned by. - ANSWER Investors or shareholders
(companies)
Not for Profit organizations do not pay - ANSWER Federal income or state/local property
taxes
Most hospitals in the US are. - ANSWER Not for Profit organizations
Medicare pays for people who. - ANSWER Are 65 and older, are in end stage renal
failure at any age, or have a disability (by prescribed definition) at any age
Four main parts of Medicare - ANSWER Part A, B, C, and D
Medicare Part A - ANS Hospital insurance; pays for inpatient hospital care and some
hospice/home healthcare
Medicare Part B - ANS Medical insurance; pays for doctor's services, outpatient care,
and PT/OT services
Medicare Part C - ANS Medicare Advantage Plan; similar to PPO insurance plan; offers
additional coverage for dental, vision, or wellness; includes parts A & B
,Medicare Part D - ANSWER Prescription drug coverage; open to all but must be covered
under a plan with part D
Medicaid covers. - ANSWER Low-income children, pregnant women, and the elderly
Medicaid pays for. - ANSWER Long term care and mandated health services
Medicaid is funded at the. - ANSWER Federal and state level
Affordable Care Act purpose - ANSWER To make affordable health insurance available
to more people and lower overall healthcare costs
Self-Pay - ANSWER A person or individual who pays for their healthcare services
Charity Pay - ANSWER Healthcare systems receive no reimbursement for services
Health Maintenance Organization HMO Insurance Plans - ANSWER Cost effective care
based on preventative care
PPO Insurance Plans - ANSWER Ability to use in-network physicians at a lower cost;
greater freedom of choice than HMO
DRG Reimbursement - ANSWER Reimbursement to the hospital depends on the average
cost for treating a specific diagnosis using the Prospective Payment System
SHMO Insurance Plans - ANSWER Covers social, health, and medical services that may
be needed
Examples of SHMO covered needs - ANSWER Adult Daycare, Meals, Transportation,
Hospice, Respite Care, etc.
, Pay for Performance (P4P) Reimbursement - ANSWER Hospitals receive financial
incentives to improve the quality of care provided
4 main quality measures for P4P reimbursement - ANSWER Performance, Outcomes,
Patient Satisfaction, and Structures/Technologies (EHR)
Value Based Purchasing - ANSWER Pay for Performance incentive program that gives
incentive payments to acute-care hospitals yearly based on total performance scores
4 major types of budgets for nurse leaders - ANSWER Revenue, Expense, Capital, and
Operating
Revenue Budget - ANSWER Anticipated amount of income during the budget period
Expense budgets are made of what four types of costs? - ANSWER Salary, Non-Salary,
Fixed, and Variable
Fixed costs remain. - ANSWER Constant
Two categories of fixed costs could be. - ANSWER Rental or contract fees
Variable costs can. - ANWER Fluctuate based on unit activity such as census and acuity
Capital Budget - ANWER Equipment and renovation expenses; "think big"
What things need to be considered when considering an item for the capital budget? (4
things) - ANWER Cost of item, installation charges, delivery/shipping charges, and if
there is a need for a service contract
