CPHRM Legal Issues 5 — Questions and Answers
Question 1: An advance directive executed in one state by a patient who is now hospitalized in a different state is:
- Automatically invalid and must be re-executed in the current state
- Generally honored under most states' reciprocity provisions, though state law varies (Correct answer)
- Only valid if notarized in the patient's home state
- Invalid unless approved by the hospital ethics committee
Correct answer: Generally honored under most states' reciprocity provisions, though state law varies
Most states have provisions to honor out-of-state advance directives to the extent they comply with the originating state's law, though risk managers should know their specific state's rules.
Question 2: The Anti-Kickback Statute prohibits knowingly and willfully offering, paying, soliciting, or receiving anything of value to induce or reward referrals of items or services covered by:
- Private commercial insurers only
- Federal healthcare programs such as Medicare and Medicaid (Correct answer)
- All payers including self-pay patients
- Out-of-network insurance plans
Correct answer: Federal healthcare programs such as Medicare and Medicaid
The Anti-Kickback Statute applies to Federal healthcare program business, primarily Medicare and Medicaid, and violations can result in criminal penalties and exclusion from federal programs.
Question 3: A 'never event' in the context of risk management and CMS policy refers to:
- An adverse event that occurs rarely but unpredictably
- A serious, preventable adverse event for which CMS does not provide additional payment (Correct answer)
- An event that must be immediately disclosed to The Joint Commission
- A sentinel event requiring mandatory state reporting
Correct answer: A serious, preventable adverse event for which CMS does not provide additional payment
CMS designates certain serious preventable adverse events as 'never events' (Hospital-Acquired Conditions) for which it will not provide additional reimbursement, incentivizing prevention.
Question 4: Under HIPAA's Breach Notification Rule, a covered entity must notify affected individuals of a breach of unsecured PHI within:
- 24 hours of discovery
- 30 days of discovery
- 60 days of discovery
- No more than 60 days of discovery (Correct answer)
Correct answer: No more than 60 days of discovery
HIPAA requires covered entities to notify affected individuals without unreasonable delay and no later than 60 calendar days after discovery of a breach of unsecured PHI.
Question 5: A patient signs a general consent for treatment upon hospital admission. For a surgical procedure, this general consent:
- Satisfies all consent requirements for the surgery
- Is sufficient only for routine nursing care; surgery requires specific informed consent (Correct answer)
- Must be renewed every 24 hours during the admission
- Covers all procedures performed during the hospitalization
Correct answer: Is sufficient only for routine nursing care; surgery requires specific informed consent
A general admission consent covers routine care, but procedures like surgery require a separate, specific informed consent process that includes risks, benefits, alternatives, and questions.
Question 6: A risk manager is reviewing a case where a patient alleges assault and battery by a healthcare provider. Battery in a medical context most commonly occurs when:
- A provider speaks harshly to a patient
- A procedure is performed without the patient's consent (Correct answer)
- A patient falls due to inadequate supervision
- A provider fails to diagnose a condition
Correct answer: A procedure is performed without the patient's consent
Medical battery occurs when a provider intentionally makes harmful or offensive contact with a patient without consent, most commonly by performing an unauthorized procedure.
Question 7: When managing a potentially compensable event (PCE), the risk manager's early intervention with the patient and family is primarily aimed at:
- Obtaining a release of liability immediately
- Building trust, gathering facts, and reducing the likelihood of litigation through transparent communication (Correct answer)
- Documenting the patient's statements for use in litigation
- Transferring the patient to reduce further liability exposure
Correct answer: Building trust, gathering facts, and reducing the likelihood of litigation through transparent communication
Early intervention in PCEs focuses on open communication, expressing empathy, conducting early fact-finding, and addressing patient/family needs, which research shows reduces the frequency and severity of malpractice claims.
CPHRM Legal Issues 5
An advance directive executed in one state by a patient who is now hospitalized in a different state is: