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NEW QUESTION # 40
A hospital is a defendant in a recently filed lawsuit involving a child with seizures and flaccid paresis, allegedly arising from negligent care during delivery 10 years ago. The plaintiff is seeking $10 million. At the time of the alleged negligence, the hospital had first dollar coverage through a commercial carrier.
Which of the following steps should the risk manager take to determine coverage before discussion with the hospital CEO and CFO?
* Review the current policy and the policy in effect for the year the delivery occurred.
* Determine whether the applicable policy is occurrence or claims made.
* Identify co-defendants insurance coverage.
* Discuss the coverage issues with the defense lawyer.
Answer: D
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, determining coverage requires careful review of the applicable insurance policies and policy structure. Because the alleged negligence occurred 10 years earlier, the risk manager must first review both the current policy and the policy in effect at the time of the delivery. Coverage depends on the specific policy terms, limits, endorsements, and retroactive dates applicable during the relevant policy period.
It is also critical to determine whether the policy is written on an occurrence or claims-made basis. Under an occurrence policy, coverage is triggered by the date of the incident, regardless of when the claim is filed.
Under a claims-made policy, coverage depends on when the claim was reported and whether appropriate tail or extended reporting coverage exists.
Identifying co-defendants' coverage may be relevant to contribution or indemnification but does not determine the hospital's own coverage. Discussion with defense counsel may assist in strategy but should follow preliminary internal coverage analysis.
Risk financing objectives emphasize accurate policy review and understanding of trigger mechanisms before executive discussions. Therefore, reviewing the relevant policies and determining policy type are essential first steps.
NEW QUESTION # 41
What factors are included in a calculation of Risk Priority Number (RPN) in FMEA?
Answer: A
Explanation:
In Failure Modes and Effects Analysis (FMEA), the Risk Priority Number (RPN) is commonly calculated as the product of three ratings:Severity (S)of impact,Occurrence (O)likelihood/probability, andDetection (D) ability to detect the failure before it causes harm (lower detectability increases risk). This structured scoring helps teams prioritize which failure modes deserve immediate mitigation. Risk management objectives include proactively identifying high-risk process steps (medication administration, specimen labeling, surgery scheduling), designing controls (standard work, forcing functions, redundancy), and tracking residual risk after changes. While cost and feasibility may influence selection of mitigations, they are not the core RPN elements. Using S-O-D improves transparency in prioritization, supports interdisciplinary alignment, and provides a defensible rationale for resource allocation toward patient safety improvements.
NEW QUESTION # 42
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
Answer: B
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 # 43
Protecting outdoor air intakes can mitigate the risk of terrorists introducing airborne agents. Steps include:
Answer: C
Explanation:
Air intake protection is a facility security and safety engineering control to reduce vulnerability to intentional contamination. Elevating intakes reduces easy access; security zones create stand-off distance; lighting and surveillance deter and improve detection. Risk management objectives emphasize layered physical security:
access control, environmental design, monitoring, and emergency response planning. In healthcare operations, these measures support resilience and continuity of care, reducing risk of mass exposure events that can overwhelm clinical capacity and cause severe harm.
NEW QUESTION # 44
Which type of information was associated with the former HIPDB (now within NPDB) but not the original NPDB focus?
Answer: D
Explanation:
The HIPDB was established to help combathealthcare fraud and abuse, while the NPDB historically focused on practitioner competence and professional conduct (including items like malpractice payments and certain adverse actions). HRSA explains that HIPDB is no longer separate and that its information is now collected and disclosed through the NPDB following the 2013 merger. For risk managers, the objective is to ensure credentialing, contracting, and compliance teams understand the expanded scope and proper use:
querying supports safer hiring/privileging decisions and reduces negligent credentialing risk, while reporting supports system integrity. Organizations must also ensure due process and correct categorization of reportable events to avoid wrongful reporting exposure.
NEW QUESTION # 45
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