CPHRM Exam Flashcards

Which body of law primarily governs healthcare risk management programs in US hospitals?

Answer: The Joint Commission standards

The Joint Commission accreditation standards establish foundational requirements for risk management programs in US hospitals.

A patient claims a nurse gave incorrect medication instructions verbally. What type of liability does this primarily represent?

Answer: Vicarious liability

Vicarious liability holds the hospital responsible for the negligent acts of its employees, including nurses, under respondeat superior.

Which metric best measures the financial impact of a hospital's risk management program?

Answer: Total cost of risk (TCOR)

Total cost of risk (TCOR) captures all costs associated with risk including premiums, retained losses, and administrative expenses.

A risk manager discovers a physician has not disclosed a financial conflict of interest. Under STARK Law, what is the primary concern?

Answer: Medicare/Medicaid fraud for prohibited referrals

The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities with which they have financial relationships.

What is the primary purpose of a claims reserve in healthcare risk management?

Answer: To estimate the future cost of pending and unreported claims

A claims reserve is a financial estimate set aside to cover the anticipated future costs of open and incurred-but-not-reported (IBNR) claims.

When a hospital employee is injured on the job, which coverage is triggered first?

Answer: Workers' compensation insurance

Workers' compensation is a no-fault system that provides mandatory coverage for employee work-related injuries and illnesses.

Which element is NOT required to establish a claim of medical negligence?

Answer: Intentional misconduct by the provider

Medical negligence (malpractice) requires duty, breach, causation, and damages — it does not require proof of intent.