CNML Test UPDATED Exam Questions and CORRECT Answers
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Course
CNML
Institution
CNML
CNML Test UPDATED Exam Questions
and CORRECT Answers
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 ...
CNML Test UPDATED Exam Questions
and CORRECT Answers
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
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)
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
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