Exam (elaborations)

CNML Test Questions With Answers Graded A+ Assured Success

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Course
CNML

Institution
CNML

Medicare - ️️Federal program that helps those over 65, those on dialysis/ESRD, and combines with state run Medicaid, younger people who are permanently disabled, and physician residency training Breakeven - ️️Needed in order not to lose money; minimum patients needed to meet budget usin...

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Uploaded on October 10, 2024
Number of pages 15
Written in 2024/2025
Type Exam (elaborations)
Contains Questions & answers

cnml

Institution CNML
Course CNML

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CNML Test
Medicare - ✔️✔️Federal program that helps those over 65, those on dialysis/ESRD,
and combines with state run Medicaid, younger people who are permanently disabled,
and physician residency training

Breakeven - ✔️✔️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

Zero-Based Budget - ✔️✔️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

Prospective Payment System - ✔️✔️Used by Medicare-participating hospitals:
pretreatment diagnosis billings based on DRGs; rate decided ahead of time between
insurance companies and hospitals

Exclusive Provider - ✔️✔️Used by HMO's: insurance coverage for contracted providers
or institutions

HMOs - ✔️✔️Health maintenance organizations: comprehensive healthcare to people
who pay a fee for a fixed period of time

Capitation - ✔️✔️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 - ✔️✔️Preferred provider organizations: special reduced rate for services when
customers use certain providers approved by the insurance company; usually fee-for-
service

IPAs - ✔️✔️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 - ✔️✔️2080 hours (1.0 @ 40 hours per week)

DRGs - ✔️✔️Diagnostic-Related Groups: payment rate based on specific diagnoses

Capital Expenses - ✔️✔️Long-term equipment or physical purchases: usually over
$500-$1000 that will last years and depreciate over time and be used multiple times

, Variance Calculation & Reminders - ✔️✔️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 - ✔️✔️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

FTE Definition & Calculation - ✔️✔️Full-time equivalent = full-time employee paid for 1
year

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

Net Revenue Calculation - ✔️✔️Gross Revenue - Deductions from Revenue (DRGs
and the Contractual allowances paid 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)

Nurse Hours Per Patient Day (HPPD) Calculation - ✔️✔️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 - ✔️✔️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 - ✔️✔️Negotiated pay for services by insurance companies regardless
of what services were actually completed; per day admitted

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CNML Test Questions With Answers Graded A+ Assured Success

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