Exam (elaborations)
CNML Test _ (SHOPIFY FUNDAMENTALS) QUESTIONS WITH 100- CORRECT ANSWERS!!.pdf
- Course
- Institution
CNML Test _ (SHOPIFY FUNDAMENTALS) QUESTIONS WITH 100- CORRECT ANSWERS!!.pdf
[Show more]
Seller
Follow
Content preview
8/30/24, 7:24 PMCNML Test
Jeremiah
Terms in this set (175)
DRGs Diagnostic-Related Groups: payment rate based on specific diagnoses
Used by Medicare-participating hospitals: pretreatment diagnosis billings based on
Prospective Payment System
DRGs; rate decided ahead of time between insurance companies and hospitals
Exclusive Provider Used by HMO's: insurance coverage for contracted providers or institutions
Health maintenance organizations: comprehensive healthcare to people who pay a fee
HMOs
for a fixed period of time
Fixed rate paid to provider per member per month for healthcare services; set fee paid
Capitation
by insurance company per month for all the patient needs
Preferred provider organizations: special reduced rate for services when customers use
PPOs
certain providers approved by the insurance company; usually fee-for-service
Individual provider arrangements: provide care in their offices for prepaid plans;
IPAs
coalition of physicians who serve HMO patients and third-party patients
Fulltime FTE Hours 2080 hours (1.0 @ 40 hours per week)
Long-term equipment or physical purchases: usually over $500-$1000 that will last
Capital Expenses
years and depreciate over time and be used multiple times
With each new budget (i.e. fiscal year), it is determined which programs/areas get
Zero-Based Budget 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 $ /Budgeted $ X 100 = % difference; contract staff on separate line of budget;
Variance Calculation & Reminders
many staff sick costs more than a few staff on LOA
Cost of Nursing Services Calculation Nurse Time X (Avg. RN Hourly Rate + Benefits + Indirects) = Total Nursing Cost per DRG
General Nurse Staffing Calculation # of RNs needed X days open / # days worked per RN
Full-time equivalent = full-time employee paid for 1 year
FTE Definition & Calculation
FTE = (Hours per shift X # of days worked) / 40 hours
Fixed Costs Stay the same no matter the census: manager salaries, keeping phones on, rent, etc.
Variable Costs Change with census and how much staffing is used
CNML Test
1/6
, 8/30/24, 7:24 PM
Gross Revenue - Deductions from Revenue (DRGs and the Contractual allowances paid
Net Revenue Calculation
by insurance companies)
UAP Unlicensed assistive personnel (CNA's)
ADC Average daily census (patients in a bed at midnight)
Total Patient Days Calculation ADC X Days open per year (for SCH - ADC X 365)
Total Direct Care Hours / Total Patient Days = # of RN hours needed to provide care for
a pt. for 24 hours.
Nurse Hours Per Patient Day (HPPD)
Calculation
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
Value-based purchasing: how CMS determines how much to reimburse a hospital for
VBP care (benchmarked standards and how they are meeting it); quality of care & following
best practice & patient experience
Negotiated pay for services by insurance companies regardless of what services were
Per Diem Rate
actually completed; per day admitted
Unit of service: patient days for inpatient nursing but could be visits or # of procedures
UOS
or whatever that healthcare organization counts
Relative value unit: what ancillary services might use to add up their UOS; # of hi-flows
RVU
hooked up or vents started for RT., for example
ALOS Calculation Average length of stay = # of pt. days / # of discharges (in same time period)
CPUOS Cost per unit of service = salaries / UOS
# of staff hours or $'s / # of UOS
RN hours / patients in beds @ midnight (HOC)
Productivity RN salaries / UOS
Output / input
Amount of work performed by a set # of staff
Minimum staff needed to operate unit usually determined by law, hospital policy, and pt
Minimum Staffing
safety
Needed in order not to lose money; minimum patients needed to meet budget using
Breakeven minimum staffing; can't control admissions but some would work with staffing office to
ensure minimum occupancy occurred
Federal program that helps those over 65, those on dialysis/ESRD, and combines with
Medicare state run Medicaid, younger people who are permanently disabled, and physician
residency training
Emergency Medical Treatment and Active Labor Act: must treat people in ED
EMTALA
regardless of ability to pay, citizenship, and legal status
A system that classifies patients by age, diagnosis, treatment, clinical, and financial
Case Mix Index
categories to develop the reimbursement rate
Productive Time 2080 hours - Benefit hours
Gross = $ charged
Revenue
Net = $ collected
OE for Budgets Operating Expenses: salaries, supplies, rent, non-productive time, etc.
CNML Test
2/6
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Denyss. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
72964 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now