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CNML Test Exam Questions and Answers 100% Solved | Graded A+

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CNML Test Exam Questions and Answers 100% Solved | Graded A+ 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 insu...

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  • October 31, 2024
  • 27
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • CNML
  • CNML
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NinjaNerd
©NINJANERD 2024/2025. YEAR PUBLISHED 2024.
CNML Test Exam Questions and

Answers 100% Solved | Graded A+


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 - ✔✔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

,©NINJANERD 2024/2025. YEAR PUBLISHED 2024.
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

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

, ©NINJANERD 2024/2025. YEAR PUBLISHED 2024.
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.

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