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Exam-CNML Exam| 175 Test Questions and Answers Rated A+

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  • Course
  • CNML
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  • CNML

Exam-CNML Exam| 175 Test Questions and Answers Rated A+

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  • September 10, 2024
  • 35
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CNML
  • CNML
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GOLDTUTORS
Exam-CNML Exam| 175 Test Questions and Answers
Rated A+
DRGs CORRECT ANS-Diagnostic-Related Groups: payment rate based on specific diagnoses




Prospective Payment System CORRECT ANS-Used by Medicare-participating hospitals:

pretreatment diagnosis billings based on DRGs; rate decided ahead of time between

insurance companies and hospitals




Exclusive Provider CORRECT ANS-Used by HMO's: insurance coverage for contracted

providers or institutions




HMOs CORRECT ANS-Health maintenance organizations: comprehensive healthcare to

people who pay a fee for a fixed period of time




Capitation CORRECT ANS-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 ANS-Preferred provider organizations: special reduced rate for services

when customers use certain providers approved by the insurance company; usually fee-for-

service

, Exam-CNML Exam| 175 Test Questions and Answers
Rated A+

IPAs CORRECT ANS-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 CORRECT ANS-2080 hours (1.0 @ 40 hours per week)




Capital Expenses CORRECT ANS-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 ANS-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 ANS-Variance $ /Budgeted $ X 100 = %

difference; contract staff on separate line of budget; many staff sick costs more than a few

staff on LOA

, Exam-CNML Exam| 175 Test Questions and Answers
Rated A+
Cost of Nursing Services Calculation CORRECT ANS-Nurse Time X (Avg. RN Hourly Rate +

Benefits + Indirects) = Total Nursing Cost per DRG




General Nurse Staffing Calculation CORRECT ANS-# of RNs needed X days open / # days

worked per RN




FTE Definition & Calculation CORRECT ANS-Full-time equivalent = full-time employee paid

for 1 year




FTE = (Hours per shift X # of days worked) / 40 hours




Fixed Costs CORRECT ANS-Stay the same no matter the census: manager salaries, keeping

phones on, rent, etc.




Variable Costs CORRECT ANS-Change with census and how much staffing is used




Net Revenue Calculation CORRECT ANS-Gross Revenue - Deductions from Revenue (DRGs

and the Contractual allowances paid by insurance companies)

, Exam-CNML Exam| 175 Test Questions and Answers
Rated A+

UAP CORRECT ANS-Unlicensed assistive personnel (CNA's)




ADC CORRECT ANS-Average daily census (patients in a bed at midnight)




Total Patient Days Calculation CORRECT ANS-ADC X Days open per year (for SCH - ADC X

365)




Nurse Hours Per Patient Day (HPPD) Calculation CORRECT ANS-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 ANS-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

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