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CNML Test Questions and Correct Verified Answers Latest Version
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DRGs Diagnostic-Related Groups: payment rate based on specific diagnoses 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 HM...

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  • October 14, 2024
  • 41
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

Subjects

  • cnml test questions and correct verified answers
  • drgs diagnostic related groups payment rate bas

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  • CNML
  • CNML

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1 | P a g e | © copyright 2024/2025 | Grade A+




CNML Test Questions and Correct
Verified Answers Latest Version
DRGs


✓ Diagnostic-Related Groups: payment rate based on specific diagnoses




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




Master01 | September, 2024/2025 | Latest update

, 1 | P a g e | © copyright 2024/2025 | Grade A+

✓ 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)




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



Master01 | September, 2024/2025 | Latest update

, 1 | P a g e | © copyright 2024/2025 | Grade A+

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




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




Master01 | September, 2024/2025 | Latest update

, 1 | P a g e | © copyright 2024/2025 | Grade A+

✓ 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)



Master01 | September, 2024/2025 | Latest update

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