CNML Test with Complete Solutions 2024/2025 DRGs - Correct Answer Diagnostic-Related Groups: payment rate based on specific diagnoses Prospective Payment System - Correct Answer Used by Medicare-participating hospitals: pretreatment diagnosis billings based on DRGs; rate decided ahead of time between insurance companies and hospitals Exclusive Provider - Correct Answer Used by HMO's: insurance coverage for contracted providers or institutions HMOs - Correct Answer Health maintenance organizations: comprehensive healthcare to people who pay a fee for a fixed period of time Capitation - Correct Answer 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 Answer Preferred provider organizations: special reduced rate for services when customers use certain providers approved by the insurance company; usually fee-for-service IPAs - Correct Answer 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 Answer 2080 hours (1.0 @ 40 hours per week) Capital Expenses - Correct Answer 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 Answer 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 Answer Variance $ /Budgeted $ X 100 = % difference; contract staff on separate line of budget; many staff sick costs more than a few staff on LOA 1 / 3
Cost of Nursing Services Calculation - Correct Answer Nurse Time X (Avg. RN Hourly Rate + Benefits + Indirects) = Total Nursing Cost per DRG General Nurse Staffing Calculation - Correct Answer # of RNs needed X days open / # days worked per RN FTE Definition & Calculation - Correct Answer Full-time equivalent = full-time employee paid for 1 year FTE = (Hours per shift X # of days worked) / 40 hours Fixed Costs - Correct Answer Stay the same no matter the census: manager salaries, keeping phones on, rent, etc.Variable Costs - Correct Answer Change with census and how much staffing is used Net Revenue Calculation - Correct Answer Gross Revenue - Deductions from Revenue (DRGs and the Contractual allowances paid by insurance companies) UAP - Correct Answer Unlicensed assistive personnel (CNA's) ADC - Correct Answer Average daily census (patients in a bed at midnight) Total Patient Days Calculation - Correct Answer ADC X Days open per year (for SCH - ADC X 365) Nurse Hours Per Patient Day (HPPD) Calculation - Correct Answer 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 Answer 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 2 / 3
Per Diem Rate - Correct Answer Negotiated pay for services by insurance companies regardless of what services were actually completed; per day admitted UOS - Correct Answer Unit of service: patient days for inpatient nursing but could be visits or # of procedures or whatever that healthcare organization counts RVU - Correct Answer Relative value unit: what ancillary services might use to add up their UOS; # of hi-flows hooked up or vents started for RT., for example ALOS Calculation - Correct Answer Average length of stay = # of pt. days / # of discharges (in same time period) CPUOS - Correct Answer Cost per unit of service = salaries / UOS Productivity - Correct Answer # of staff hours or $'s / # of UOS RN hours / patients in beds @ midnight (HOC) RN salaries / UOS Output / input Amount of work performed by a set # of staff Minimum Staffing - Correct Answer Minimum staff needed to operate unit usually determined by law, hospital policy, and pt safety Breakeven - Correct Answer 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
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