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| Section | Objectives |
|---|---|
| Topic 1: Claims and Litigation Management | - Claims investigation and management processes - Litigation support and documentation handling |
| Topic 2: Clinical and Patient Safety | - Clinical risk reduction strategies - Patient safety principles and frameworks - Adverse event analysis and reporting |
| Topic 3: Legal, Regulatory, and Ethical Issues | - Consent, confidentiality, and documentation standards - Ethical considerations in healthcare risk management - Healthcare law and regulatory compliance |
| Topic 4: Healthcare Risk Management Program Administration | - Program development and governance - Performance measurement and improvement |
| Topic 5: Healthcare Risk Management Foundations | - Risk identification and assessment methods - Principles of healthcare risk management - Risk mitigation strategies |
| Topic 6: Risk Financing and Insurance | - Captive insurance and self-insurance models - Risk financing mechanisms - Insurance structures in healthcare |
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NEW QUESTION # 33
Which of the following items should be part of a claim file?
* peer review reports or data
* correspondence with attorneys and investigators
* literature search
* verification of settlement authority
Answer: D
Explanation:
According to Health Care Risk Management standards outlined by ASHRM and the American Hospital Association Certification Center, claim files must be carefully structured to preserve confidentiality, protect privilege, and support effective defense strategy. A claim file typically includes correspondence with attorneys and investigators, as this documentation reflects legal strategy, communications, and case development. Literature searches relevant to standards of care may also be included to assist counsel in evaluating clinical issues and expert testimony preparation. Verification of settlement authority is essential documentation to confirm that appropriate approvals were obtained before resolving a claim.
Peer review reports or data, however, should not be included in the claim file. Peer review materials are generally protected under state peer review statutes and federal patient safety privilege provisions.
Commingling peer review documents within the claims file may jeopardize privilege protections and increase the risk of discoverability in litigation. Maintaining separation between peer review files and claim files is a critical risk management practice.
Claims and litigation objectives emphasize preservation of privilege, organized documentation, and compliance with legal standards. Therefore, correspondence, literature searches, and settlement authority verification belong in the claim file, while peer review reports should be maintained separately.
NEW QUESTION # 34
A 22-year-old man has been treated at a hospital for a psychiatric condition. His mother requests that a copy of the patient's medical record be released to her. The risk manager's advice to the medical records department should be to
Answer: A
NEW QUESTION # 35
Root Cause Analyses most often reveal that mistakes are a result of:
Answer: B
Explanation:
RCA and systems safety models (e.g., Swiss Cheese) emphasize that adverse events typically requiremultiple contributing factors-small process breakdowns, latent conditions, and active failures-to align. This is why focusing only on the last person who touched the patient ("sharp end blame") rarely prevents recurrence. Risk management objectives are to identify and strengthen defenses: policies, training, equipment design, staffing models, communication standards, and redundancy where needed. A series-of-events understanding enables targeted corrective actions (forcing functions, standardization, automation with safeguards, independent double checks for high-alert processes). It also supports just culture: accountability is preserved for reckless behavior, but most improvement comes from redesigning systems that make errors more likely. This approach improves reliability, reduces repeat harm, and provides defensible evidence of organizational learning and corrective action.
NEW QUESTION # 36
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: 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 # 37
An original contract could contain:
Answer: D
Explanation:
Healthcare contracting is a risk control tool. Core terms include effective date, scope, responsibilities, performance standards, indemnification, andinsurance requirements(limits, additional insured, notice of cancellation). Clear terms reduce disputes, clarify liability allocation, and strengthen compliance (HIPAA BAAs, data security, subcontractor controls). Risk management objectives focus on preventing uninsured exposures and ensuring vendors meet safety, credentialing, and regulatory requirements-especially for clinical services, technology, and facility operations.
NEW QUESTION # 38
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