Claims Management Flashcards
7 cards from real CPHRM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Claims Management flashcards as text
Which document formally notifies a healthcare organization that a patient intends to pursue legal action?
Answer: Notice of intent
A notice of intent is a pre-suit document that formally alerts a healthcare provider of a patient's intent to file a malpractice claim.
In claims management, 'excess exposure' refers to a situation where:
Answer: Potential damages exceed available policy limits
Excess exposure occurs when a claim's potential verdict or settlement value surpasses the organization's insurance policy limits, creating personal financial risk.
A healthcare risk manager discovers a pattern of similar medication errors across three departments. The BEST first action is to:
Answer: Conduct a root cause analysis and implement system-wide corrective action
Identifying systemic issues through root cause analysis and implementing corrective actions addresses the underlying problem and prevents future claims.
Which legal doctrine holds a hospital liable for the negligent acts of its employees performed within the scope of their employment?
Answer: Respondeat superior
Respondeat superior ('let the master answer') makes employers vicariously liable for employees' negligent acts committed within the scope of employment.
When evaluating a claim for early resolution, which factor MOST influences the decision to offer a settlement?
Answer: Liability exposure combined with potential damages
Settlement decisions are primarily driven by assessing the strength of liability and the magnitude of potential damages if the case proceeds to trial.
The primary purpose of a claims reserve is to:
Answer: Estimate the financial liability for pending claims
A claims reserve is a financial estimate set aside to cover the anticipated cost of settling or litigating a pending claim.
Which element is NOT required to establish a medical malpractice claim?
Answer: Intent to harm
Medical malpractice is a negligence-based claim requiring duty, breach, causation, and damages — intent to harm is not an element of negligence.