CNML Exam Review Questions and
Answers 100% Solved | Graded A+
Biggest difference between For Profit Organizations vs Not for Profit
Organizations - FP Organizations do not follow EMTALA. They can
lawfully release a patient who does not have the ability to pay for services.
NFP organizations a...
Preferred Provider Organization (PPO) Insurance Plans - ✔✔Option to
utilize in-network physicians for a lower cost; more options than HMO
Diagnosis Related Group (DRG) Reimbursement - ✔✔Reimbursement to
the hospital is based on the average cost of services for a specific
diagnosis using the Prospective Payment System
Social Health Maintenance Organization (SHMO) Insurance Plans -
✔✔Covers for social, health, and medical services that may be needed
Examples of SHMO covered needs - ✔✔Adult Daycare, Meals,
Transportation, Hospice, Respite Care, etc.
Pay for Performance (P4P) Reimbursement - ✔✔Hospitals receive financial
incentives to improve the quality of care provided
4 main quality measures for P4P reimbursement - ✔✔Performance,
Outcomes, Patient Satisfaction, and Structures/Technologies (EHR)
Value Based Purchasing - ✔✔Pay for Performance incentive program that
gives incentive payments to acute-care hospitals yearly based on total
performance scores
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