CNML Test
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
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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
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. 2 / 3
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
Per Diem Rate - correct answer Negotiated pay for services by insurance companies regardless of what services were actually completed; per day admitted
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