DMEC CLMS ACTUAL PAPER 2026
PROFESSIONAL CLAIMS SCENARIOS
VERIFIED OUTCOMES
◉ EMTALA.
Answer: Emergency Medical Treatment and Active Labor Act: must
treat people in ED regardless of ability to pay, citizenship, and legal
status
◉ Case Mix Index.
Answer: A system that classifies patients by age, diagnosis,
treatment, clinical, and financial categories to develop the
reimbursement rate
◉ Productive Time.
Answer: 2080 hours - Benefit hours
◉ Revenue.
Answer: Gross = $ charged
Net = $ collected
◉ OE for Budgets.
,Answer: Operating Expenses: salaries, supplies, rent, non-productive
time, etc.
◉ Margin.
Answer: Difference between expenses and how much money is
collected
Margins down = less gross or net income
Margins up = more gross or net income
◉ Workload Per Day.
Answer: Total workload hours / 365 days / 24 hours
◉ Costs in a Budget.
Answer: Fixed, variable & non-recurring (like installing new piece of
equipment or 100th anniversary party for the hospital)
◉ Replacement Factor.
Answer: Adding up the benefit time because nurses don't actually
work 2080 hours per year; add this to the total FTE's
◉ HCAHPS.
, Answer: Hospital Consumer Assessment of Healthcare Providers
and Systems: national survey asking patients how their stay was
◉ National Labor Relations Act (NLRA).
Answer: (AKA: Wagner Act) Passed to end the depression; prevented
employers from cutting wages; lots of power to unions/employees;
1974 amendments created union needs to give notice before
striking, no strikes during notice time, written notice to employers
about new contract need, mediation needs, board of inquiry to settle
disputes, and allowed employees to bow out of joining; created
unfair labor practices against employers from stopping unions or
discriminating against union employees
Rights of unions/workers
◉ Labor Management Relations Act.
Answer: (AKA: Taft-Hartley Act) Listed union restrictions to even
out rights between employees and employers from the
NLRA/Wagner Act; placed restrictions on labor organizations like
forcing employees to join or refusing to bargain; created code of
contact for unions
Rights of management
◉ Civil Rights Act of 1964.
PROFESSIONAL CLAIMS SCENARIOS
VERIFIED OUTCOMES
◉ EMTALA.
Answer: Emergency Medical Treatment and Active Labor Act: must
treat people in ED regardless of ability to pay, citizenship, and legal
status
◉ Case Mix Index.
Answer: A system that classifies patients by age, diagnosis,
treatment, clinical, and financial categories to develop the
reimbursement rate
◉ Productive Time.
Answer: 2080 hours - Benefit hours
◉ Revenue.
Answer: Gross = $ charged
Net = $ collected
◉ OE for Budgets.
,Answer: Operating Expenses: salaries, supplies, rent, non-productive
time, etc.
◉ Margin.
Answer: Difference between expenses and how much money is
collected
Margins down = less gross or net income
Margins up = more gross or net income
◉ Workload Per Day.
Answer: Total workload hours / 365 days / 24 hours
◉ Costs in a Budget.
Answer: Fixed, variable & non-recurring (like installing new piece of
equipment or 100th anniversary party for the hospital)
◉ Replacement Factor.
Answer: Adding up the benefit time because nurses don't actually
work 2080 hours per year; add this to the total FTE's
◉ HCAHPS.
, Answer: Hospital Consumer Assessment of Healthcare Providers
and Systems: national survey asking patients how their stay was
◉ National Labor Relations Act (NLRA).
Answer: (AKA: Wagner Act) Passed to end the depression; prevented
employers from cutting wages; lots of power to unions/employees;
1974 amendments created union needs to give notice before
striking, no strikes during notice time, written notice to employers
about new contract need, mediation needs, board of inquiry to settle
disputes, and allowed employees to bow out of joining; created
unfair labor practices against employers from stopping unions or
discriminating against union employees
Rights of unions/workers
◉ Labor Management Relations Act.
Answer: (AKA: Taft-Hartley Act) Listed union restrictions to even
out rights between employees and employers from the
NLRA/Wagner Act; placed restrictions on labor organizations like
forcing employees to join or refusing to bargain; created code of
contact for unions
Rights of management
◉ Civil Rights Act of 1964.
