Attested CPHRM Dumps PDF Resource [2026]
Latest CPHRM Actual Free Exam Questions Updated 123 Questions
NEW QUESTION # 70
A risk manager is reviewing the hospital's incident reporting system and notices that very few medication errors are being reported despite known high volumes of medication administration. Which of the following is the MOST appropriate action?
- A. Conduct a root cause analysis on the reporting system.
- B. Assess the organizational culture and barriers to reporting.
- C. Discipline staff members for failure to report errors.
- D. Notify the liability insurer immediately.
Answer: B
Explanation:
Within Health Care Risk Management frameworks supported by ASHRM and the American Hospital Association Certification Center, effective incident reporting systems depend heavily on organizational culture. When underreporting is identified, the most appropriate first step is to evaluate whether a just culture exists and whether staff perceive reporting as safe, nonpunitive, and constructive. Fear of retaliation, lack of feedback, time constraints, and unclear reporting procedures are common barriers that suppress reporting rates.
A punitive response such as disciplining staff may further discourage transparency and undermine patient safety initiatives. Conducting a root cause analysis may be appropriate if a specific adverse event occurred, but in this scenario the systemic issue is underreporting itself, which is primarily cultural and operational in nature. Immediate notification of the liability insurer would not address the underlying safety system weakness.
Health care operations objectives emphasize creating a culture of safety that encourages voluntary reporting, learning, and system improvement. By assessing and strengthening reporting culture, leadership can improve data accuracy, enhance early risk identification, and support proactive patient safety management.
NEW QUESTION # 71
The following is a table of expense and indemnity figures for an organization's last 6 years.
What is the ratio of total incurred expense to total incurred indemnity for Year 4?
- A. 0.18
- B. 3.23
- C. 0.20
- D. 0.15
Answer: C
Explanation:
According to Health Care Risk Management principles supported by ASHRM and the American Hospital Association Certification Center, total incurred amounts include both paid amounts and reserves. Incurred expense equals expense paid plus expense reserves. Incurred indemnity equals indemnity paid plus indemnity reserves.
For Year 4:
Total incurred expense = $25,000 reserves + $15,000 paid = $40,000.
Total incurred indemnity = $150,000 reserves + $75,000 paid = $225,000.
The ratio of total incurred expense to total incurred indemnity is calculated as:
$40,000 ÷ $225,000 = 0.1778, which rounds to approximately 0.18.
However, among the answer options provided, the closest value is 0.20 only if rounded broadly. Since precise calculation yields approximately 0.18, the mathematically correct ratio is approximately 0.18.
In risk financing analysis, expense-to-indemnity ratios help evaluate claims handling efficiency and cost allocation. Monitoring this ratio assists in forecasting defense costs, evaluating litigation management strategies, and supporting actuarial review. Accurate calculation of incurred values is essential for financial planning and reserve adequacy assessment.
NEW QUESTION # 72
When conducting a safety audit in an Emergency Department, what does an administrator need to obtain first?
- A. A list of staff birthdays
- B. A marketing plan
- C. A written set of safety standards/criteria for the audit
- D. A patient satisfaction script
Answer: C
Explanation:
A safety audit must be anchored to explicitstandards-policies, regulatory requirements, evidence-based guidelines, and internal procedures-so observations can be evaluated objectively. Without defined criteria, the audit becomes subjective and inconsistent, limiting its usefulness and defensibility. Risk management objectives for ED audits include verifying compliance with high-risk workflows (triage, medication storage, high-alert meds, behavioral health safety, EMTALA processes, handoff communication, alarm management), identifying hazards (environmental risks, crowding, staffing mismatch), and ensuring corrective actions are tracked to closure. A written standard also supports repeatability-audits can be compared over time, and improvements can be measured. This approach aligns with quality management principles: define the requirement, assess the gap, implement controls, and monitor effectiveness.
NEW QUESTION # 73
All of the following are valid reasons for performing risk management review of policies and procedures EXCEPT
- A. identifying potential risk exposures.
- B. maintaining staff competency.
- C. monitoring compliance with standards.
- D. ensuring consistency between practice and policy.
Answer: B
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, periodic review of policies and procedures is essential to ensure alignment with current laws, regulatory standards, accreditation requirements, and best practices. Reviewing policies helps ensure consistency between written procedures and actual clinical practice, thereby reducing liability exposure.
Policy review also supports identification of potential risk exposures by detecting outdated language, conflicting guidance, or gaps in processes that could lead to adverse events. Additionally, monitoring compliance with standards-such as federal regulations, state statutes, and accreditation requirements-is a central purpose of policy review, ensuring that organizational practices meet required benchmarks.
Maintaining staff competency, however, is primarily addressed through education, training programs, credentialing, and performance evaluation processes. While policies provide guidance for staff conduct, competency assessment is not the primary objective of policy review itself.
Health Care Operations objectives emphasize governance oversight, regulatory compliance, and risk mitigation through clear, current policies. Therefore, maintaining staff competency is not a direct reason for performing risk management review of policies and procedures, making it the correct exception.
NEW QUESTION # 74
According to The Joint Commission, which of the following should be done to patient-owned electrical devices entering the facility?
- A. conduct an electrical safety inspection
- B. sequester the electrical device
- C. tag by biomedical engineering
- D. inventory with patient belongings
Answer: A
Explanation:
According to Health Care Risk Management standards supported by ASHRM and accreditation guidance from The Joint Commission, patient-owned electrical devices brought into healthcare facilities must be evaluated to ensure they do not pose safety risks. The Joint Commission's Environment of Care standards emphasize electrical safety, fire prevention, and reduction of hazards within patient care areas.
Before a patient-owned electrical device is used within the facility, an electrical safety inspection should be conducted to assess the integrity of cords, plugs, grounding, and overall condition. The purpose is to identify potential risks such as frayed wiring, overheating hazards, or improper voltage compatibility that could endanger patients, staff, or equipment.
Simply inventorying the device with personal belongings does not address safety concerns. Sequestering the device may be appropriate if it fails inspection, but routine confiscation is not required. While biomedical engineering departments often assist with inspections, tagging by biomedical engineering is not itself the required action; the essential requirement is that a safety inspection be performed.
Clinical and patient safety objectives emphasize proactive hazard identification and compliance with accreditation standards. Therefore, conducting an electrical safety inspection is the appropriate action for patient-owned electrical devices entering the facility.
NEW QUESTION # 75
An emergency department physician has evaluated and stabilized a patient who needs a sign language interpreter. The on-call physician is consulted for admission. Which of the following regulatory laws are most relevant?
- A. HCQIA and ADA
- B. ADA and EMTALA/COBRA
- C. EMTALA/COBRA and HIPAA
- D. HIPAA and HCQIA
Answer: B
Explanation:
Under Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, two federal laws are most directly implicated in this scenario: the Americans with Disabilities Act ADA and the Emergency Medical Treatment and Labor Act EMTALA, formerly enacted under COBRA.
EMTALA requires hospitals with emergency departments to provide an appropriate medical screening examination, stabilization of emergency medical conditions, and appropriate transfer or admission regardless of ability to pay. Since the emergency physician has evaluated and stabilized the patient and the on-call physician is being consulted for admission, EMTALA obligations remain central to ensuring compliant continuation of care.
The ADA is also directly relevant because it mandates that health care organizations provide reasonable accommodations to individuals with disabilities, including effective communication. For a patient requiring a sign language interpreter, the hospital must provide appropriate auxiliary aids and services to ensure meaningful access to care.
HIPAA relates primarily to privacy and protected health information, while HCQIA addresses peer review immunity and credentialing matters. Therefore, ADA and EMTALA are the most relevant regulatory frameworks in this case.
NEW QUESTION # 76
Which of the following has been proven to reduce costs of workers' compensation programs?
- A. employee disciplinary actions
- B. early return-to-work programs
- C. comprehensive departmental safety analyses
- D. employee assistance programs
Answer: B
Explanation:
Within Health Care Risk Management frameworks endorsed by ASHRM and the American Hospital Association Certification Center, early return-to-work programs are recognized as one of the most effective strategies for controlling workers' compensation costs. These programs facilitate the safe and timely return of injured employees to modified or transitional duty consistent with medical restrictions.
Workers' compensation costs are significantly influenced by wage replacement benefits and duration of disability. By reducing the length of time an employee remains off work, early return-to-work initiatives directly decrease indemnity payments, lower claim severity, and improve overall claim outcomes.
Additionally, such programs support employee morale, maintain productivity, and reduce the likelihood of prolonged disability or litigation.
While comprehensive safety analyses contribute to injury prevention and long-term risk reduction, their direct cost impact is preventive rather than immediately measurable in claim severity. Employee assistance programs focus primarily on behavioral health and personal support, not claim cost containment. Disciplinary actions do not constitute a structured risk financing strategy and may negatively affect organizational culture.
Therefore, from a risk financing perspective, early return-to-work programs have demonstrated measurable effectiveness in reducing workers' compensation program costs.
NEW QUESTION # 77
Ultimately, the accountability for the risk management program belongs to:
- A. The parking contractor
- B. A single bedside nurse
- C. The board
- D. The gift shop manager
Answer: C
Explanation:
Boards are ultimately accountable for oversight of organizational risk, including patient safety, quality, compliance, and financial sustainability. While executives and risk leaders manage day-to-day operations, board governance sets expectations, ensures resources, monitors performance, and holds leadership accountable for corrective action. Risk management objectives at the governance level include approving risk appetite, reviewing top enterprise risks, ensuring systems exist for event reporting and learning, and verifying that mitigation plans are implemented and effective. In litigation and regulatory scrutiny, board oversight can be a critical factor: a board that demands transparency, tracks harm signals, and supports safety investment strengthens the organization's defensibility and reduces preventable harm.
NEW QUESTION # 78
People make fewer errors when:
- A. Errors are hidden to protect reputations
- B. Individuals work alone to avoid distraction
- C. Speed is prioritized over verification
- D. Staff work as a coordinated team with shared communication tools
Answer: D
Explanation:
Team-based care reduces errors by improving communication, cross-monitoring, workload distribution, and escalation when risk increases. TeamSTEPPS and related patient safety evidence show teamwork training can improve safety culture and reduce clinical error rates by creating predictable behaviors-briefs, huddles, check-backs, and mutual support. From a risk management standpoint, teamwork is a high-leverage control because many serious adverse events involve coordination failures (handoffs, unclear ownership, missed deterioration). Effective teams also reduce "single-point-of-failure" risk; when one clinician misses something, another can catch it. Organizations operationalize this through standardized communication (SBAR), structured handoffs, simulation, and leadership support for psychological safety so staff speak up.
Team functioning is therefore not "soft skill"-it is a measurable safety barrier that reduces preventable harm and strengthens reliability in complex, high-acuity environments.
NEW QUESTION # 79
A clear directive to a nurse is:
- A. "Monitor the infusion pump's operation at defined intervals and document checks."
- B. "Do your best."
- C. "Be careful."
- D. "If you have time, look at it."
Answer: A
Explanation:
Clear directives are specific, measurable, and time-bound-reducing ambiguity and variability that drive frontline error. "Monitor every so often" becomes safer when translated into a defined interval (e.g., every 15 minutes for the first hour, then hourly), with documentation requirements and escalation triggers. Risk management objectives emphasize standard work and reliable monitoring for high-risk equipment such as infusion pumps because device malfunction or programming errors can rapidly cause harm. Clear directives also support accountability and defensibility: they demonstrate the organization defined expectations and trained staff accordingly. Vague instructions ("be careful") do not reliably change behavior or outcomes. In high-reliability care, clarity is a safety barrier: it reduces cognitive load, prevents missed steps, and improves handoffs between staff by making the plan visible and verifiable.
NEW QUESTION # 80
A physician dies upon arrival to the emergency department from her home following a gunshot wound to the chest. The police report a history of domestic violence. The organization is required to notify the
- A. organization's public relations department.
- B. Department of Health and Family Services.
- C. Office of the Medical Examiner.
- D. state Board of Medicine.
Answer: C
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, deaths resulting from violent, traumatic, or suspicious circumstances are legally reportable to the appropriate medico-legal authority, typically the Office of the Medical Examiner or Coroner. A gunshot wound constitutes a violent and potentially criminal cause of death, triggering statutory reporting requirements.
When a patient is pronounced dead on arrival due to trauma, particularly with a history suggestive of domestic violence, the death falls within the jurisdiction of the medical examiner. The medical examiner has authority to determine cause and manner of death, order autopsy if indicated, and coordinate with law enforcement to preserve forensic evidence. Hospitals are required by state law to notify this office promptly.
The state Board of Medicine oversees professional licensure and discipline, not death investigation. The Department of Health and Family Services may have reporting roles for public health matters, but traumatic deaths are typically handled by the medical examiner. The public relations department may manage communications but is not a regulatory notification requirement.
Legal and regulatory objectives emphasize compliance with mandatory reporting statutes and preservation of evidence. Therefore, the appropriate entity to notify is the Office of the Medical Examiner.
NEW QUESTION # 81
A hospital's Ethics Committee is seeking advice on a case involving the elective sterilization of an adolescent patient who is developmentally disabled. One of the parents is refusing consent. The risk manager should evaluate which of the following?
* who has consent authority
* competency level of the patient
* diagnosis of the patient
* state statutes and laws
- A. 2, 3, and 4 only
- B. 1, 3, and 4 only
- C. 1, 2, and 4 only
- D. 1, 2, and 3 only
Answer: C
Explanation:
Under Health Care Risk Management principles outlined by ASHRM and the American Hospital Association Certification Center, cases involving sterilization of minors, particularly those who are developmentally disabled, raise significant legal and regulatory concerns. The risk manager's primary responsibility is to ensure compliance with applicable consent laws and protect patient rights while minimizing organizational liability.
First, determining who has legal consent authority is essential. When parents disagree, state law typically governs whether both parents must consent, whether one parent's consent is sufficient, or whether court involvement is required. Second, evaluating the competency level of the patient is critical because decision- making capacity influences whether the patient can participate in consent or assent processes. Capacity assessments may require clinical and legal evaluation.
Third, state statutes and laws are highly relevant, as many jurisdictions impose strict legal requirements or court approval for sterilization of minors or individuals with developmental disabilities. These laws are designed to protect vulnerable populations.
The patient's diagnosis alone is not the determining legal factor; rather, decision-making capacity and statutory requirements are central. Therefore, the risk manager must evaluate consent authority, competency, and applicable state laws to ensure regulatory compliance and ethical integrity.
NEW QUESTION # 82
A hospital's blood transfusions are99.7% error-free. Which function best estimates how many transfusions are likely before an error occurs?
- A. Multinomial distribution
- B. Geometric distribution (time until first failure)
- C. Linear regression
- D. Chi-square test
Answer: B
Explanation:
If each transfusion has an independent probability of error, the number of transfusions until thefirsterror is modeled by thegeometric distribution, which describes "trials until first failure." The expected number of transfusions before an error is approximately, so. Risk management objectives use this type of reliability thinking to convert percentages into operational intuition: "Even a 0.3% error rate becomes a predictable event in high-volume processes." That insight supports prioritizing controls (barcoding, two-person verification, bedside ID checks, standardized labeling, transfusion time-outs) because rare-event rates still produce real harm over time. Interpreting reliability this way also helps boards and leaders understand that
"99.x%" can be unsafe in critical processes and that system redesign is often necessary to reach high reliability.
NEW QUESTION # 83
In enterprise risk management, which of the following are external factors that may affect risk?
- A. Option C
- B. Option B
- C. Option A
- D. Option D
Answer: A
Explanation:
According to Health Care Risk Management standards supported by ASHRM and enterprise risk management ERM principles, external factors include conditions outside the direct control of the organization that influence strategic, operational, financial, and regulatory risk exposures.
A physician shortage is an external workforce market condition that can affect staffing stability, access to care, and malpractice exposure. New regulations are also external factors, as legislative or regulatory changes may alter compliance requirements, reimbursement structures, or reporting obligations. Similarly, soft insurance market trends reflect external economic and underwriting environments that influence premium pricing, availability of coverage, and risk financing strategy.
Resolution of claims, however, is generally an internal operational or claims management outcome. While influenced by external legal environments, the resolution process itself is primarily part of internal risk management and litigation strategy rather than a broad external environmental factor.
ERM objectives emphasize analysis of external environmental drivers, including regulatory, workforce, economic, and market conditions. Therefore, physician shortages, new regulations, and soft insurance market trends are external factors affecting risk, while resolution of claims is not primarily classified as external.
NEW QUESTION # 84
An appropriate way to complete the verification read-back of a complete order, as required by The Joint Commission National Patient Safety Goals, is to have the person receiving the order
- A. immediately repeat the information.
- B. write the information down before reading it back.
- C. document the date and time the order was received.
- D. have a witness verify that the information is repeated back correctly.
Answer: B
Explanation:
According to Health Care Risk Management standards supported by ASHRM and The Joint Commission National Patient Safety Goals, the read-back process is designed to ensure accurate communication of verbal or telephone orders. The correct process requires the person receiving the order to first write down the complete order and then read it back to the prescribing practitioner for verification.
Writing the order down before reading it back reduces reliance on memory and decreases the risk of omission or transcription errors. The practitioner who gave the order must then confirm that the read-back is accurate.
This closed-loop communication process enhances patient safety and reduces medication and treatment errors associated with miscommunication.
Immediately repeating the information without documenting it does not meet the full verification requirement, as the written record must be confirmed. A witness is not required under the standard. Documenting the date and time is necessary for proper charting but does not constitute completion of the read-back verification itself.
Clinical and patient safety objectives emphasize clear, structured communication processes. Therefore, writing the information down before reading it back is the appropriate method to complete the verification process.
NEW QUESTION # 85
Which of the following is an essential component of a risk management policy and procedure manual?
- A. medical staff bylaws
- B. loss run report
- C. actuarial report
- D. department organizational chart
Answer: D
Explanation:
According to Health Care Risk Management standards outlined by ASHRM and the American Hospital Association Certification Center, a risk management policy and procedure manual should clearly define the structure, authority, and operational framework of the risk management program. An organizational chart is an essential component because it identifies reporting relationships, lines of authority, and accountability within the department and in relation to executive leadership and governing bodies.
A clearly documented organizational structure supports regulatory compliance, facilitates communication, and ensures that responsibilities for event reporting, claims management, patient safety initiatives, and regulatory oversight are properly assigned. It also demonstrates governance alignment and helps accrediting bodies evaluate program effectiveness.
Medical staff bylaws are separate governance documents that outline credentialing, peer review, and clinical governance standards. Actuarial reports are financial analyses used in risk financing decisions but are not part of a policy and procedure manual. Loss run reports summarize historical claims activity and support financial review but do not define program structure.
Health Care Operations objectives emphasize formal documentation of authority, processes, and accountability within the risk management framework. Therefore, inclusion of the department organizational chart is an essential element of a comprehensive risk management policy and procedure manual.
NEW QUESTION # 86
If an at-risk patient is left unattended and has an adverse response to medication, this is best classified as:
- A. An active error at the sharp end (frontline lapse)
- B. A financial risk transfer
- C. A marketing defect
- D. A harmless variance
Answer: A
Explanation:
Leaving an at-risk patient unattended during/after medication administration is typically anactive failure occurring at thesharp end-the point of direct care delivery. Active errors are the observable actions
/omissions by frontline personnel that can immediately contribute to harm (e.g., failure to monitor sedation, failure to reassess after opioids). Risk management objectives, however, require looking beyond the individual act: Was staffing insufficient? Was monitoring policy unclear? Were alarms ineffective? Was there inadequate training or workload overload? Those "blunt end" conditions create latent risk that increases the likelihood of sharp-end failures. Proper classification helps organizations respond with systems fixes (monitoring standards, escalation triggers, staffing acuity tools, continuous pulse oximetry/capnography policies where appropriate) rather than blaming individuals alone.
NEW QUESTION # 87
Which sentinel event type has been reported among the most frequent categories in Joint Commission-related analyses (noting year-to-year variation)?
- A. Parking disputes
- B. Cafeteria food complaints
- C. Falls (recent years show high frequency)
- D. Gift shop inventory loss
Answer: C
Explanation:
Sentinel event "most common" can change by reporting year and classification approach. Recent summaries of 2023 sentinel event reporting indicatefallswere the most frequently reported category in that dataset, with wrong surgery and unintended retention also high-ranking. Risk management objectives treat this as a dynamic signal: the organization should use current event data, internal trends, and unit-specific hazards to prioritize controls. Falls prevention requires layered interventions-risk stratification, mobility support, medication review, environmental controls, and post-fall huddles to learn and redesign. Leaders should avoid over-fixating on one historical "most common" event type and instead use current surveillance to target the biggest preventable harm burdens.
NEW QUESTION # 88
Which of the following factors should be considered when setting or adjusting indemnity reserves?
* incurred medical expenses
* emotional pain and suffering
* medical expert witness costs
* future cost of medical care
- A. 2, 3, and 4 only
- B. 1, 3, and 4 only
- C. 1, 2, and 4 only
- D. 1, 2, and 3 only
Answer: C
Explanation:
According to Health Care Risk Management principles established by ASHRM and the American Hospital Association Certification Center, indemnity reserves represent the estimated amount the organization expects to pay in settlement or judgment to a claimant. Indemnity refers specifically to damages paid to compensate the injured party, not defense or administrative expenses.
Incurred medical expenses are a core component of economic damages and must be included in indemnity reserve calculations. Emotional pain and suffering fall under non-economic damages and are also considered when estimating potential settlement or verdict value. Future cost of medical care is another essential factor, particularly in cases involving long-term injury or disability, as it represents projected economic damages that may substantially increase exposure.
Medical expert witness costs, however, are categorized as defense expenses and are typically included in allocated loss adjustment expenses rather than indemnity reserves. These costs relate to the defense of the claim rather than compensation to the plaintiff.
Risk management objectives emphasize accurate differentiation between indemnity and expense reserves to ensure proper financial reporting and regulatory compliance. Therefore, incurred medical expenses, pain and suffering, and future medical costs should be considered when setting indemnity reserves, while expert witness costs should not.
NEW QUESTION # 89
The first layer of insurance that will respond to a specific type of loss or exposure is called
- A. foundation.
- B. primary.
- C. baseline.
- D. frontline.
Answer: B
Explanation:
According to Health Care Risk Management principles supported by ASHRM and the American Hospital Association Certification Center, insurance coverage for liability exposures is often structured in layers. The first layer of insurance that responds to a covered loss is known as the primary policy.
Primary insurance provides initial coverage once any applicable deductible or self-insured retention has been satisfied. It is responsible for defense and indemnity payments up to the policy's stated per-occurrence and aggregate limits. Only after the primary policy limits are exhausted do excess or umbrella policies respond.
Terms such as baseline, foundation, and frontline are not recognized technical classifications in layered insurance structures. In professional and general liability programs, organizations commonly maintain a primary layer followed by one or more excess layers to protect against catastrophic losses.
Risk financing objectives emphasize understanding policy structure, limits, attachment points, and coordination between layers to ensure adequate protection of organizational assets. Therefore, the correct term for the first layer of insurance that responds to a loss is the primary policy.
NEW QUESTION # 90
If there is no OSHA standard for a given potential health hazard, OSHA may:
- A. Have no authority at all
- B. Transfer it to the FDA
- C. Ignore it if it is expensive
- D. Govern it under the General Duty Clause
Answer: D
Explanation:
OSHA can cite employers under theGeneral Duty Clausewhen a recognized serious hazard exists and no specific standard applies. Risk management objectives require proactive hazard identification and controls even when regulations are not prescriptive: risk assessments, engineering controls where feasible, administrative controls (policies, training), and PPE as a final layer. In healthcare, this is relevant for emerging hazards (novel chemical exposures, workplace violence risks, certain ergonomic hazards) where specific standards may be limited. Maintaining documentation of hazard recognition and mitigation is essential for defensibility during inspections and for staff safety outcomes.
NEW QUESTION # 91
Which of the following isnotone of the patient rights enumerated in the Patient Self-Determination Act (PSDA)?
- A. The right to refuse treatment through an advance directive (where applicable)
- B. The right to participate in decisions about medical care
- C. The right to select any medication the patient wants
- D. The right to receive information about advance directives
Answer: C
Explanation:
The PSDA focuses onpatient autonomy and informed decision-making, especially aroundadvance directives. It requires certain healthcare organizations to inform patients of their rights under state law to make decisions about medical care, ask whether the patient has an advance directive, document it, and avoid discrimination based on whether an advance directive exists. The Act doesnotcreate a right for patients to select any medication they want irrespective of clinical appropriateness, prescribing laws, formularies, allergies, contraindications, or standards of care. Risk management objectives here include: ensuring compliant admission workflows (education + documentation), reducing disputes through early clarification of preferences, and preventing ethical/legal breakdowns during incapacity. Operationally, PSDA compliance improves care planning, reduces unwanted treatment, and lowers complaint/litigation risk by showing the organization respected patient rights and followed required processes.
NEW QUESTION # 92
A claims manager needs to open a loss reserve and perform an investigation of an event. They review the patient demographics, the nature and extent of the injury, and other liability factors. Which of the following would be helpful to the claims manager in determining a loss reserve?
- A. the patient's total medical bills
- B. the surgery center's claims history
- C. comparable verdicts in the county
- D. amount of insurance allowed per occurrence
Answer: C
Explanation:
Within Health Care Risk Management practice as outlined by ASHRM and the American Hospital Association Certification Center, establishing an accurate loss reserve requires an estimation of the probable financial exposure associated with a claim. A loss reserve represents the anticipated cost to resolve a claim, including indemnity payments and defense expenses.
Comparable verdicts in the county are particularly useful because they reflect jurisdiction-specific jury tendencies, local legal climate, and historical award patterns. Venue significantly influences claim valuation, as jury awards can vary substantially between counties and states. Reviewing similar case outcomes allows the claims manager to benchmark potential settlement or verdict ranges based on injury severity and liability factors.
The surgery center's claims history may inform overall risk trends but does not directly determine the value of a specific claim. The patient's total medical bills are relevant but represent only one component of damages and do not account for non-economic damages such as pain and suffering. The insurance limit per occurrence defines maximum exposure but does not guide the realistic reserve estimate unless damages approach policy limits.
Therefore, analysis of comparable local verdicts is most helpful in establishing an appropriate and defensible loss reserve.
NEW QUESTION # 93
If a practitioner requests a telemedicine consult with another practitioner in another state, the consultant:
- A. Can rely on verbal permission from the ED nurse
- B. Never needs any license
- C. Can practice under the patient's insurance plan only
- D. May need to hold a valid license in the patient's state (requirements vary by state)
Answer: D
Explanation:
Telemedicine licensure is largely state-based in the U.S., and many states require the consulting clinician to be licensed in the state where the patient is located (with exceptions such as specific compacts, special telehealth registrations, or emergency provisions). Risk management objectives include verifying licensure
/credentialing before services, ensuring privileging-by-proxy processes where applicable, confirming malpractice coverage for telehealth and cross-state practice, and ensuring informed consent/privacy safeguards. Failure to comply can trigger regulatory penalties, payer issues, and liability exposure if care is delivered without proper authorization.
NEW QUESTION # 94
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