CPHRM CPHRM Exam 5 — Questions and Answers
Question 1: Which standard requires healthcare organizations to have a written patient rights policy?
- OSHA Bloodborne Pathogen Standard
- The Joint Commission Patient Rights (RI) standards (Correct answer)
- CMS Conditions of Participation, Billing
- State workers' compensation statutes
Correct answer: The Joint Commission Patient Rights (RI) standards
The Joint Commission's Rights and Responsibilities of the Individual (RI) chapter requires hospitals to define and protect patient rights in written policy.
Question 2: What is the statute of limitations in healthcare malpractice, and why does it matter to risk managers?
- It limits the dollar amount a plaintiff can recover
- It sets the time window within which a lawsuit must be filed (Correct answer)
- It restricts which courts can hear the case
- It defines the standard of care for each specialty
Correct answer: It sets the time window within which a lawsuit must be filed
The statute of limitations sets the deadline by which a plaintiff must file suit; understanding it helps risk managers assess exposure duration for open events.
Question 3: A hospital negotiates a risk-sharing contract with a health plan where it accepts financial risk for patient outcomes. This is an example of:
- Traditional fee-for-service billing
- Value-based care / shared risk contracting (Correct answer)
- Capitation fraud
- Stop-loss elimination
Correct answer: Value-based care / shared risk contracting
Value-based contracts shift financial risk to providers based on quality metrics and patient outcomes, requiring robust clinical risk management.
Question 4: Which document outlines how a patient's healthcare decisions should be made if they become incapacitated?
- Medical staff bylaws
- Advance directive (Correct answer)
- Certificate of insurance
- Incident report
Correct answer: Advance directive
An advance directive (e.g., living will, healthcare proxy) documents a patient's wishes for care and designates a surrogate decision-maker if capacity is lost.
Question 5: When evaluating an occurrence-based versus claims-made policy, what is the key advantage of an occurrence-based policy?
- Lower premium costs in all circumstances
- Coverage for claims reported after the policy expires as long as the incident occurred during coverage
- No need for a tail coverage endorsement
- Both B and C (Correct answer)
Correct answer: Both B and C
Occurrence-based policies cover any incident that occurred during the policy period regardless of when the claim is filed, eliminating the need to purchase tail coverage.
Question 6: Under the Americans with Disabilities Act (ADA), a hospital must:
- Hire only fully abled healthcare professionals
- Provide reasonable accommodations to qualified employees with disabilities (Correct answer)
- Exclude disabled patients from elective procedures
- Report all staff disabilities to The Joint Commission
Correct answer: Provide reasonable accommodations to qualified employees with disabilities
The ADA requires employers, including hospitals, to provide reasonable accommodations to qualified individuals with disabilities unless doing so causes undue hardship.
Question 7: A hospital's risk manager reviews loss runs and notices a spike in slip-and-fall claims in one unit. The best immediate risk control action is:
- Increase the SIR for premises liability
- Conduct a focused environmental walkthrough and implement corrective measures (Correct answer)
- Transfer all claims to excess insurer
- Notify state health department of the trend
Correct answer: Conduct a focused environmental walkthrough and implement corrective measures
Targeted environmental inspections and corrective action address the hazard directly and are the appropriate risk control response to a localized claims spike.
CPHRM CPHRM Exam 5
Which standard requires healthcare organizations to have a written patient rights policy?