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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Litigation | 20% | - Manage claims processes and documentation - Evaluate litigation outcomes and lessons learned - Coordinate litigation support and defense - Analyze claims data for risk patterns - Implement claims prevention strategies |
| Topic 2: Healthcare Operations | 20% | - Evaluate operational risk controls - Identify operational risks in healthcare settings - Implement risk management in clinical operations - Address workplace violence and safety - Manage emergency preparedness and response |
| Topic 3: Clinical/Patient Safety | 25% | - Evaluate effectiveness of patient safety initiatives - Analyze clinical data to identify risks and trends - Collaborate on proactive safety initiatives (FMEA, RCA, Safety Culture/Just Culture) - Implement patient safety programs and interventions - Assess patient safety state and staff awareness |
| Topic 4: Legal and Regulatory | 20% | - Manage legal risks and liabilities - Analyze legal trends and precedents - Develop policies for legal compliance - Ensure compliance with regulatory requirements - Interpret healthcare laws and regulations |
| Topic 5: Risk Financing | 15% | - Analyze risk transfer mechanisms - Identify and analyze risk financing options - Manage self-insurance and captive programs - Develop risk financing strategies - Evaluate insurance programs and coverage |
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NEW QUESTION # 22
According to The Joint Commission, which of the following should be done to patient-owned electrical devices entering the facility?
Answer: C
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 # 23
An organization has recently changed insurance. The risk manager receives a claim from a former patient on July 3, 2004, claiming injury and alleging negligence by the surgery staff on September 5, 2003. Which of the following would apply to this claim?
* a claims-made policy for the period 1/1/03 to 1/1/04 with a retro date of 1/1/02
* an occurrence policy for the period 1/1/03 to 1/1/04
* a claims-made policy for the period 1/1/03 to 1/1/04 with a 1-year tail coverage
* an occurrence policy for the period 1/1/04 to 1/1/05
Answer: D
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, coverage determination depends on both the policy trigger and relevant dates. The alleged negligence occurred on September 5, 2003. Under an occurrence policy in effect from 1/1
/03 to 1/1/04, coverage applies because the event occurred during that policy period, regardless of when the claim was filed. Therefore, option 2 applies.
For a claims-made policy covering 1/1/03 to 1/1/04, coverage would require that the claim be made and reported during the policy period unless tail coverage is in place. Because the claim was received on July 3,
2004, after expiration of the 1/1/03 to 1/1/04 claims-made policy, coverage would apply only if a 1-year tail was purchased. Thus, option 3 applies.
Option 1 would not apply because the claim was made after the claims-made policy period ended, and no tail is specified. Option 4 would not apply because occurrence coverage from 1/1/04 to 1/1/05 would not cover an event that occurred in 2003.
Risk financing objectives emphasize understanding policy triggers, reporting requirements, and tail coverage.
Therefore, the applicable coverage scenarios are the occurrence policy for 2003 and the claims-made policy with tail coverage.
NEW QUESTION # 24
What group reports information (historically HIPDB content; now within NPDB) related to fraud/abuse oversight?
Answer: C
Explanation:
The Healthcare Integrity and Protection Data Bank (HIPDB) was created to combat healthcare fraud and abuse; it isno longer operational as a separate bank, and its content was merged into the NPDB. Reporting and querying are governed by HRSA rules defining authorized entities, including certain peer review and oversight organizations in specific reporting frameworks. Risk management objectives include ensuring organizations understand which actions must be reported, ensure due process, and comply with data handling rules. Proper reporting supports system integrity by preventing practitioners or entities with serious adverse actions from moving undetected across organizations. For hospitals and health plans, this strengthens credentialing and contracting decisions, reducing organizational exposure to negligent credentialing and improper network participation risks.
NEW QUESTION # 25
The due diligence process in acquisitions is undertaken to:
Answer: C
Explanation:
Due diligence is a structured risk-identification and validation process used in mergers/acquisitions to understand clinical, legal, regulatory, operational, and financial exposures before closing. Objectives include discovering hidden liabilities (claims history, compliance gaps, credentialing issues, cybersecurity risks), validating revenue assumptions, assessing quality and safety maturity, and estimating integration costs. This informs valuation (including potential price adjustments), deal terms (representations/warranties, indemnities), and post-close priorities to improve performance and reduce adverse surprises. Risk management objectives include ensuring continuity of safe care during transition, aligning policies and governance, and preventing inherited regulatory violations or claims tail exposures.
NEW QUESTION # 26
The Patient Safety and Quality Improvement Act of 2005 includes provisions to
* amend the Public Health Service Act to establish procedures for the voluntary confidential reporting of medical errors.
* enable the creation of patient safety organizations PSOs.
* require mandatory reporting to PSOs.
* classify patient safety work product reported to PSOs as privileged and confidential.
Answer: A
Explanation:
According to Health Care Risk Management standards established by ASHRM and the American Hospital Association Certification Center, the Patient Safety and Quality Improvement Act of 2005 amended the Public Health Service Act to promote voluntary reporting of patient safety events. The Act established a federal framework to encourage confidential reporting and analysis of medical errors in order to improve patient safety.
The law enabled the creation and certification of Patient Safety Organizations PSOs, which collect and analyze patient safety data submitted by healthcare providers. Importantly, the Act designates patient safety work product submitted to PSOs as privileged and confidential, providing federal legal protections against disclosure in most civil, criminal, or administrative proceedings. This privilege encourages candid reporting and system-wide learning.
However, reporting to PSOs is voluntary, not mandatory. The Act was specifically designed to foster participation by offering confidentiality protections rather than imposing compulsory reporting requirements.
Legal and regulatory objectives in healthcare risk management emphasize understanding the scope of federal protections and ensuring proper designation and handling of patient safety work product. Therefore, provisions 1, 2, and 4 are correct, while mandatory reporting to PSOs is not required under the Act.
NEW QUESTION # 27
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