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Exam-CNML Exam| 175 Test Questions and Answers Rated A+
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Exam-CNML Exam| 175 Test Questions and Answers Rated A+
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Exam-CNML Exam| 175 Test Questions and AnswersRated A+
DRGs CORRECT ANS-Diagnostic-Related Groups: payment rate based on specific diagnoses
Prospective Payment System CORRECT ANS-Used by Medicare-participating hospitals:
pretreatment diagnosis billings based on DRGs; rate decided ahead of time between
insurance companies and hospitals
Exclusive Provider CORRECT ANS-Used by HMO's: insurance coverage for contracted
providers or institutions
HMOs CORRECT ANS-Health maintenance organizations: comprehensive healthcare to
people who pay a fee for a fixed period of time
Capitation CORRECT ANS-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 ANS-Preferred provider organizations: special reduced rate for services
when customers use certain providers approved by the insurance company; usually fee-for-
service
, Exam-CNML Exam| 175 Test Questions and Answers
Rated A+
IPAs CORRECT ANS-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 CORRECT ANS-2080 hours (1.0 @ 40 hours per week)
Capital Expenses CORRECT ANS-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 ANS-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 ANS-Variance $ /Budgeted $ X 100 = %
difference; contract staff on separate line of budget; many staff sick costs more than a few
staff on LOA
, Exam-CNML Exam| 175 Test Questions and Answers
Rated A+
Cost of Nursing Services Calculation CORRECT ANS-Nurse Time X (Avg. RN Hourly Rate +
Benefits + Indirects) = Total Nursing Cost per DRG
General Nurse Staffing Calculation CORRECT ANS-# of RNs needed X days open / # days
worked per RN
FTE Definition & Calculation CORRECT ANS-Full-time equivalent = full-time employee paid
for 1 year
FTE = (Hours per shift X # of days worked) / 40 hours
Fixed Costs CORRECT ANS-Stay the same no matter the census: manager salaries, keeping
phones on, rent, etc.
Variable Costs CORRECT ANS-Change with census and how much staffing is used
Net Revenue Calculation CORRECT ANS-Gross Revenue - Deductions from Revenue (DRGs
and the Contractual allowances paid by insurance companies)
, Exam-CNML Exam| 175 Test Questions and Answers
Rated A+
UAP CORRECT ANS-Unlicensed assistive personnel (CNA's)
ADC CORRECT ANS-Average daily census (patients in a bed at midnight)
Total Patient Days Calculation CORRECT ANS-ADC X Days open per year (for SCH - ADC X
365)
Nurse Hours Per Patient Day (HPPD) Calculation CORRECT ANS-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 ANS-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
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