CRS DC CERTIFICATION EVALUATION
FULL SOLUTION REVIEW SHEET GRADED
A+
●● Prospective Payment System
Answer: Used by Medicare-participating hospitals: pretreatment
diagnosis billings based on DRGs; rate decided ahead of time between
insurance companies and hospitals
●● Exclusive Provider
Answer: Used by HMO's: insurance coverage for contracted providers
or institutions
●● HMOs
Answer: Health maintenance organizations: comprehensive healthcare to
people who pay a fee for a fixed 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: 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
,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)
●● Nurse Hours Per Patient Day (HPPD) Calculation
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
FULL SOLUTION REVIEW SHEET GRADED
A+
●● Prospective Payment System
Answer: Used by Medicare-participating hospitals: pretreatment
diagnosis billings based on DRGs; rate decided ahead of time between
insurance companies and hospitals
●● Exclusive Provider
Answer: Used by HMO's: insurance coverage for contracted providers
or institutions
●● HMOs
Answer: Health maintenance organizations: comprehensive healthcare to
people who pay a fee for a fixed 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: 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
,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)
●● Nurse Hours Per Patient Day (HPPD) Calculation
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
