CNML Test with Complete Solutions 2024/2025
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 b...
CNML Test with Complete Solutions 2024/2025
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
Minimum Staffing - Correct Answer Minimum staff needed to operate unit usually determined by
law, hospital policy, and pt safety
Breakeven - Correct Answer Needed in order not to lose money; minimum patients needed to meet
budget using minimum staffing; can't control admissions but some would work with staffing office to
ensure minimum occupancy occurred
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