CNML Test Practice Exam with Answers (175 Solved Questions)
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CNML Test
1. DRGs Diagnostic-Related Groups: payment rate based on spe-
cific diagnoses
2. Prospective Pay-
ment System
Used by Medicare-participating hospitals: pretreatment
diagnosis billings based on DRGs; rate decided ahead of
time between insurance companies and hospitals
3. Exclusive
Provider
Used by HMO's: insurance coverage for contracted
providers or institutions
4. HMOs Health maintenance organizations: comprehensive
healthcare to people who pay a fee for a fixed period of
time
5. 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
6. PPOs Preferred provider organizations: special reduced rate for
services when customers use certain providers approved
by the insurance company; usually fee-for-service
7. IPAs Individual provider arrangements: provide care in their
offices for prepaid plans; coalition of physicians who serve
HMO patients and third-party patients
8. Fulltime FTE
Hours
2080 hours (1.0 @ 40 hours per week)
9. Capital Expens-
es
Long-term equipment or physical purchases: usually over
$500-$1000 that will last years and depreciate over time
and be used multiple times
10. Zero-Based Bud-
get
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
11.
1 / 18
1. DRGs Diagnostic-Related Groups: payment rate based on spe-
cific diagnoses
2. Prospective Pay-
ment System
Used by Medicare-participating hospitals: pretreatment
diagnosis billings based on DRGs; rate decided ahead of
time between insurance companies and hospitals
3. Exclusive
Provider
Used by HMO's: insurance coverage for contracted
providers or institutions
4. HMOs Health maintenance organizations: comprehensive
healthcare to people who pay a fee for a fixed period of
time
5. 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
6. PPOs Preferred provider organizations: special reduced rate for
services when customers use certain providers approved
by the insurance company; usually fee-for-service
7. IPAs Individual provider arrangements: provide care in their
offices for prepaid plans; coalition of physicians who serve
HMO patients and third-party patients
8. Fulltime FTE
Hours
2080 hours (1.0 @ 40 hours per week)
9. Capital Expens-
es
Long-term equipment or physical purchases: usually over
$500-$1000 that will last years and depreciate over time
and be used multiple times
10. Zero-Based Bud-
get
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
11.
1 / 18
CNML Test
Variance Calcu-
lation & Re-
minders
Variance $ /Budgeted $ X 100 = % difference; contract
staff on separate line of budget; many staff sick costs
more than a few staff on LOA
12. Cost of Nursing
Services Calcu-
lation
Nurse Time X (Avg. RN Hourly Rate + Benefits + Indi-
rects) = Total Nursing Cost per DRG
13. General Nurse
Staffing Calcula-
tion
# of RNs needed X days open / # days worked per RN
14. FTE Definition &
Calculation
Full-time equivalent = full-time employee paid for 1 year
FTE = (Hours per shift X # of days worked) / 40 hours
15. Fixed Costs Stay the same no matter the census: manager salaries,
keeping phones on, rent, etc.
16. Variable Costs Change with census and how much staffing is used
17. Net Revenue Cal-
culation
Gross Revenue - Deductions from Revenue (DRGs and
the Contractual allowances paid by insurance compa-
nies)
18. UAP Unlicensed assistive personnel (CNA's)
19. ADC Average daily census (patients in a bed at midnight)
20. Total Patient
Days Calculation
ADC X Days open per year (for SCH - ADC X 365)
21. Nurse Hours
Per Patient Day
(HPPD) Calcula-
tion
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
22. VBP
2 / 18
Variance Calcu-
lation & Re-
minders
Variance $ /Budgeted $ X 100 = % difference; contract
staff on separate line of budget; many staff sick costs
more than a few staff on LOA
12. Cost of Nursing
Services Calcu-
lation
Nurse Time X (Avg. RN Hourly Rate + Benefits + Indi-
rects) = Total Nursing Cost per DRG
13. General Nurse
Staffing Calcula-
tion
# of RNs needed X days open / # days worked per RN
14. FTE Definition &
Calculation
Full-time equivalent = full-time employee paid for 1 year
FTE = (Hours per shift X # of days worked) / 40 hours
15. Fixed Costs Stay the same no matter the census: manager salaries,
keeping phones on, rent, etc.
16. Variable Costs Change with census and how much staffing is used
17. Net Revenue Cal-
culation
Gross Revenue - Deductions from Revenue (DRGs and
the Contractual allowances paid by insurance compa-
nies)
18. UAP Unlicensed assistive personnel (CNA's)
19. ADC Average daily census (patients in a bed at midnight)
20. Total Patient
Days Calculation
ADC X Days open per year (for SCH - ADC X 365)
21. Nurse Hours
Per Patient Day
(HPPD) Calcula-
tion
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
22. VBP
2 / 18
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