CPHRM Claims Management 4

Question 1

In the context of healthcare claims, 'occurrence reporting' is BEST described as:

Accepted Answer

Notifying the insurer of events that may lead to a claim, even before one is filed

Answer

Occurrence reporting to insurers involves notifying them of incidents or events with claim potential before a formal claim is made, preserving coverage and enabling early investigation.

Question 2

Which principle guides the concept that a healthcare provider owes a heightened standard of care to patients who are incapacitated or vulnerable?

Accepted Answer

Special relationship doctrine

Answer

The special relationship doctrine recognizes that certain relationships, such as provider-patient, impose heightened duties of care and protection.

Question 3

A hospital settles a malpractice claim for $150,000. Under the National Practitioner Data Bank (NPDB) rules, this payment must be reported:

Accepted Answer

Within 30 days of the payment

Answer

NPDB regulations require that all medical malpractice payments made on behalf of a licensed healthcare practitioner be reported within 30 days.

Question 4

Which alternative dispute resolution method uses a neutral third party who renders a binding decision?

Accepted Answer

Arbitration

Answer

Arbitration involves a neutral arbitrator who hears both sides and issues a binding decision, unlike mediation where the neutral only facilitates negotiation.

Question 5

In a comparative negligence jurisdiction, a plaintiff found 40% at fault for their own injury can recover:

Accepted Answer

60% of the total damages awarded

Answer

Under pure comparative negligence, a plaintiff's recovery is reduced by their percentage of fault, so 40% fault yields 60% of the total damages.

CPHRM Exam Practice Test

CPHRM Exam Practice Test

CPHRM Claims Management 4