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ASHRM CPHRM Exam Syllabus Topics:
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NEW QUESTION # 30
A risk manager is investigating a claim that has been submitted to the malpractice carrier. There is some question as to whether or not there is coverage under the current malpractice policy. What might the risk manager expect to receive from the malpractice carrier?
- A. reservation of rights letter
- B. notice of right to rescind
- C. notice of right to deny coverage
- D. contingent acknowledgement of coverage
Answer: A
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, when an insurer identifies potential issues regarding coverage under a liability policy, it commonly issues a reservation of rights letter. This letter informs the insured that the carrier will proceed with investigation or defense of the claim while reserving its right to later deny coverage if policy exclusions, conditions, or other limitations apply.
A reservation of rights protects the insurer from waiving its ability to contest coverage while fulfilling its duty to defend, depending on policy language. It also alerts the insured to potential conflicts of interest and may permit the insured to seek independent counsel in certain jurisdictions.
A contingent acknowledgment of coverage is not a standard legal instrument. A notice of right to deny coverage would typically follow a full coverage determination rather than precede it. A notice of right to rescind involves voiding a policy, usually due to material misrepresentation during underwriting, which is distinct from a routine coverage question.
Claims and litigation objectives emphasize careful review of policy terms and timely communication with insurers. Therefore, when coverage is uncertain, the risk manager should expect to receive a reservation of rights letter from the malpractice carrier.
NEW QUESTION # 31
The Joint Commission requires that after a healthcare organization becomes aware of a sentinel event, it must complete a root cause analysis and action plan within how many days?
- A. 0
- B. 1
- C. 2
- D. 3
Answer: B
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, The Joint Commission's sentinel event policy requires organizations to complete a thorough root cause analysis and develop an action plan within 45 days of becoming aware of the sentinel event.
The root cause analysis must identify underlying system failures and contributing factors rather than focusing solely on individual performance. The resulting action plan must outline specific corrective measures, assign responsibility, establish implementation timelines, and include mechanisms to monitor effectiveness. The emphasis is on sustainable system improvement to reduce the likelihood of recurrence.
Failure to complete the analysis and action plan within the required timeframe may result in additional review, accreditation consequences, or other follow-up actions by The Joint Commission. Timely completion demonstrates organizational accountability, leadership oversight, and commitment to patient safety.
Clinical and patient safety objectives emphasize structured investigation processes, documentation of corrective actions, and alignment with accreditation standards. Therefore, the required timeframe for completion of the root cause analysis and action plan following awareness of a sentinel event is 45 days.
NEW QUESTION # 32
A subpoena duces tecum requires the recipient to
* produce specified documents.
* appear at a deposition or trial.
* provide a list of all parties involved.
* disclose the names of expert witnesses.
- A. 3 and 4 only
- B. 2 and 4 only
- C. 1 and 3 only
- D. 1 and 2 only
Answer: D
Explanation:
Within Health Care Risk Management practice as outlined by ASHRM and the American Hospital Association Certification Center, understanding legal process documents is essential to effective claims management and litigation response. A subpoena duces tecum is a court-issued legal instrument requiring an individual or organization to produce specified documents, records, or tangible evidence relevant to a legal proceeding.
In many jurisdictions, a subpoena duces tecum may also require the recipient to appear at a deposition, hearing, or trial while producing the requested documents. The key distinguishing feature is the command to bring documents or evidence. Compliance is mandatory unless successfully challenged or quashed by the court.
Providing a list of all parties involved or disclosing expert witness identities are generally handled through formal discovery processes such as interrogatories, requests for production, or court-ordered disclosures, not specifically by a subpoena duces tecum.
Claims and litigation objectives emphasize prompt review of subpoenas, coordination with legal counsel, protection of privileged information, and timely compliance to avoid sanctions. Therefore, a subpoena duces tecum requires production of specified documents and may also compel appearance, making options 1 and 2 correct.
NEW QUESTION # 33
What is one advantage of avoluntaryerror reporting system over amandatoryerror reporting system?
- A. Voluntary systems guarantee legal privilege in all states
- B. Voluntary systems replace peer review and credentialing
- C. Voluntary systems typically elicit more frontline reports and near-misses
- D. Voluntary systems eliminate the need for root cause analysis
Answer: C
Explanation:
Voluntary reporting systems often generatemore reports, especially ofnear-misses and low-harm events, because staff perceive less punitive risk and greater learning value. This is crucial for proactive risk management: near-misses expose weak signals and system vulnerabilities before a patient is harmed. A robust voluntary culture supports a "just culture" approach-encouraging reporting while still holding people accountable for reckless behavior. Compared with mandatory systems (typically limited to defined serious events), voluntary systems improve the organization's ability to identify patterns (communication failures, workflow traps, labeling issues, staffing risks), prioritize interventions, and measure improvement over time.
Risk management objectives include earlier hazard detection, better trend analysis, and stronger safety culture. To maximize effectiveness, leadership must provide feedback loops ("you reported, we improved"), protect confidentiality where permitted, and couple reporting with structured analysis (RCA/FMEA). While voluntary reporting does not automatically confer legal privilege, it is a foundational learning system in high- reliability healthcare operations.
NEW QUESTION # 34
Information from the Data Bank (NPDB; includes former HIPDB content) can be requested by:
- A. Any member of the public
- B. Patients requesting a clinician's full file
- C. Social media investigators
- D. Professional societies with formal peer review (as permitted)
Answer: D
Explanation:
Access to NPDB information is restricted to authorized entities for credentialing, privileging, and oversight- not public browsing. HRSA's NPDB rules identify who can query and report;professional societies with formal peer revieware listed among entities that may query under certain circumstances. This limited-access model supports patient safety objectives by enabling credentialing bodies to identify adverse licensure actions, certain negative clinical privilege actions, and other reportable events, while protecting due process and confidentiality. From a risk management perspective, proper querying supports defensible credentialing and reduces negligent credentialing exposure. Equally important: organizations must maintain secure handling of NPDB responses and follow permitted-use rules to avoid compliance violations.
NEW QUESTION # 35
A hospital is a defendant in a recently filed lawsuit involving a child with seizures and flaccid paresis, allegedly arising from negligent care during delivery 10 years ago. The plaintiff is seeking $10 million. At the time of the alleged negligence, the hospital had first dollar coverage through a commercial carrier.
Which of the following steps should the risk manager take to determine coverage before discussion with the hospital CEO and CFO?
* Review the current policy and the policy in effect for the year the delivery occurred.
* Determine whether the applicable policy is occurrence or claims made.
* Identify co-defendants insurance coverage.
* Discuss the coverage issues with the defense lawyer.
- A. 3 and 4 only
- B. 2 and 4 only
- C. 1 and 3 only
- D. 1 and 2 only
Answer: D
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, determining coverage requires careful review of the applicable insurance policies and policy structure. Because the alleged negligence occurred 10 years earlier, the risk manager must first review both the current policy and the policy in effect at the time of the delivery. Coverage depends on the specific policy terms, limits, endorsements, and retroactive dates applicable during the relevant policy period.
It is also critical to determine whether the policy is written on an occurrence or claims-made basis. Under an occurrence policy, coverage is triggered by the date of the incident, regardless of when the claim is filed.
Under a claims-made policy, coverage depends on when the claim was reported and whether appropriate tail or extended reporting coverage exists.
Identifying co-defendants' coverage may be relevant to contribution or indemnification but does not determine the hospital's own coverage. Discussion with defense counsel may assist in strategy but should follow preliminary internal coverage analysis.
Risk financing objectives emphasize accurate policy review and understanding of trigger mechanisms before executive discussions. Therefore, reviewing the relevant policies and determining policy type are essential first steps.
NEW QUESTION # 36
What factors are included in a calculation of Risk Priority Number (RPN) in FMEA?
- A. Legal privilege, media attention, reputation
- B. Cost, staff satisfaction, marketing risk
- C. Severity, occurrence (probability), detection
- D. Insurance premiums, deductibles, coinsurance
Answer: C
Explanation:
In Failure Modes and Effects Analysis (FMEA), the Risk Priority Number (RPN) is commonly calculated as the product of three ratings:Severity (S)of impact,Occurrence (O)likelihood/probability, andDetection (D) ability to detect the failure before it causes harm (lower detectability increases risk). This structured scoring helps teams prioritize which failure modes deserve immediate mitigation. Risk management objectives include proactively identifying high-risk process steps (medication administration, specimen labeling, surgery scheduling), designing controls (standard work, forcing functions, redundancy), and tracking residual risk after changes. While cost and feasibility may influence selection of mitigations, they are not the core RPN elements. Using S-O-D improves transparency in prioritization, supports interdisciplinary alignment, and provides a defensible rationale for resource allocation toward patient safety improvements.
NEW QUESTION # 37
The following is a table of expense and indemnity figures for an organization's last 6 years.
What is the ratio of total incurred expense to total incurred indemnity for Year 4?
- A. 3.23
- B. 0.20
- C. 0.15
- D. 0.18
Answer: B
Explanation:
According to Health Care Risk Management principles supported by ASHRM and the American Hospital Association Certification Center, total incurred amounts include both paid amounts and reserves. Incurred expense equals expense paid plus expense reserves. Incurred indemnity equals indemnity paid plus indemnity reserves.
For Year 4:
Total incurred expense = $25,000 reserves + $15,000 paid = $40,000.
Total incurred indemnity = $150,000 reserves + $75,000 paid = $225,000.
The ratio of total incurred expense to total incurred indemnity is calculated as:
$40,000 รท $225,000 = 0.1778, which rounds to approximately 0.18.
However, among the answer options provided, the closest value is 0.20 only if rounded broadly. Since precise calculation yields approximately 0.18, the mathematically correct ratio is approximately 0.18.
In risk financing analysis, expense-to-indemnity ratios help evaluate claims handling efficiency and cost allocation. Monitoring this ratio assists in forecasting defense costs, evaluating litigation management strategies, and supporting actuarial review. Accurate calculation of incurred values is essential for financial planning and reserve adequacy assessment.
NEW QUESTION # 38
Which of the following items should be part of a claim file?
* peer review reports or data
* correspondence with attorneys and investigators
* literature search
* verification of settlement authority
- A. 2, 3, and 4 only
- B. 1, 2, and 3 only
- C. 1, 3, and 4 only
- D. 1, 2, and 4 only
Answer: A
Explanation:
According to Health Care Risk Management standards outlined by ASHRM and the American Hospital Association Certification Center, claim files must be carefully structured to preserve confidentiality, protect privilege, and support effective defense strategy. A claim file typically includes correspondence with attorneys and investigators, as this documentation reflects legal strategy, communications, and case development. Literature searches relevant to standards of care may also be included to assist counsel in evaluating clinical issues and expert testimony preparation. Verification of settlement authority is essential documentation to confirm that appropriate approvals were obtained before resolving a claim.
Peer review reports or data, however, should not be included in the claim file. Peer review materials are generally protected under state peer review statutes and federal patient safety privilege provisions.
Commingling peer review documents within the claims file may jeopardize privilege protections and increase the risk of discoverability in litigation. Maintaining separation between peer review files and claim files is a critical risk management practice.
Claims and litigation objectives emphasize preservation of privilege, organized documentation, and compliance with legal standards. Therefore, correspondence, literature searches, and settlement authority verification belong in the claim file, while peer review reports should be maintained separately.
NEW QUESTION # 39
An organization has recently changed insurance. The risk manager receives a claim from a former patient on July 3, 2004, claiming injury and alleging negligence by the surgery staff on September 5, 2003. Which of the following would apply to this claim?
* a claims-made policy for the period 1/1/03 to 1/1/04 with a retro date of 1/1/02
* an occurrence policy for the period 1/1/03 to 1/1/04
* a claims-made policy for the period 1/1/03 to 1/1/04 with a 1-year tail coverage
* an occurrence policy for the period 1/1/04 to 1/1/05
- A. 1 and 4 only
- B. 3 and 4 only
- C. 2 and 3 only
- D. 1 and 2 only
Answer: C
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, coverage determination depends on both the policy trigger and relevant dates. The alleged negligence occurred on September 5, 2003. Under an occurrence policy in effect from 1/1
/03 to 1/1/04, coverage applies because the event occurred during that policy period, regardless of when the claim was filed. Therefore, option 2 applies.
For a claims-made policy covering 1/1/03 to 1/1/04, coverage would require that the claim be made and reported during the policy period unless tail coverage is in place. Because the claim was received on July 3,
2004, after expiration of the 1/1/03 to 1/1/04 claims-made policy, coverage would apply only if a 1-year tail was purchased. Thus, option 3 applies.
Option 1 would not apply because the claim was made after the claims-made policy period ended, and no tail is specified. Option 4 would not apply because occurrence coverage from 1/1/04 to 1/1/05 would not cover an event that occurred in 2003.
Risk financing objectives emphasize understanding policy triggers, reporting requirements, and tail coverage.
Therefore, the applicable coverage scenarios are the occurrence policy for 2003 and the claims-made policy with tail coverage.
NEW QUESTION # 40
Supervisors who conduct job interviews may ask which of the following questions?
- A. Are you currently taking a prescription medication?
- B. Are you a citizen of the United States?
- C. Do you plan to have children?
- D. Can you meet the organization's attendance requirement?
Answer: D
Explanation:
Under Health Care Risk Management standards aligned with ASHRM and the American Hospital Association Certification Center, employment interview questions must comply with federal and state anti-discrimination laws, including the Americans with Disabilities Act ADA, Title VII of the Civil Rights Act, the Pregnancy Discrimination Act, and the Immigration Reform and Control Act.
Questions about prescription medications may violate ADA provisions by eliciting information about potential disabilities prior to a conditional offer of employment. Asking whether a candidate plans to have children may constitute unlawful discrimination based on sex or family status. Inquiring directly about citizenship may violate federal employment eligibility standards; employers may instead ask whether the applicant is legally authorized to work in the United States.
In contrast, asking whether a candidate can meet the organization's attendance requirements is permissible because it relates directly to essential job functions and business necessity. Employers may inquire about the ability to perform job-related duties, provided questions are applied consistently to all applicants and are not designed to screen out protected classes.
Legal and regulatory objectives emphasize nondiscriminatory hiring practices and adherence to equal employment laws. Therefore, questions regarding attendance requirements are appropriate in a job interview setting.
NEW QUESTION # 41
An organization's chief of orthopedics has scheduled an implant of a new artificial hip for the next day. The chief developed the artificial hip while working as a consultant for a medical device company. The device has not yet been approved by the FDA or the Institutional Review Board. The risk manager's best immediate course of action is to
- A. call the chief of surgery to discuss canceling the procedure.
- B. call a special meeting of the Institutional Review Board.
- C. contact the FDA to clarify the status of the device.
- D. verify the informed consent for the procedure.
Answer: A
Explanation:
Under Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, the implantation of a medical device that lacks FDA approval and Institutional Review Board oversight presents significant legal and regulatory violations. Use of an unapproved device outside of an approved investigational protocol may violate federal regulations governing human subject research and medical device approval processes.
The risk manager's primary responsibility is to immediately mitigate regulatory and liability exposure.
Because the procedure is scheduled for the next day, urgent intervention is required. Contacting the FDA would not resolve the immediate risk. Verifying informed consent is insufficient, as patient consent cannot legitimize use of an unapproved device outside regulatory pathways. Calling a special IRB meeting would not retroactively authorize an unapproved device without appropriate investigational device exemption processes.
Escalating the issue to the chief of surgery to halt or cancel the procedure is the most appropriate immediate step. This ensures that organizational leadership addresses the compliance violation before patient harm occurs. Risk management objectives emphasize proactive prevention of regulatory breaches, protection of patient safety, and preservation of institutional integrity. Therefore, stopping the procedure is the correct and immediate action.
NEW QUESTION # 42
Per The Joint Commission and CMS patient visitation standards, a hospital may restrict an individual's ability to visit a patient if the visitor
- A. is not the patient's immediate family member.
- B. is known to be a drug seeker in the community.
- C. administered the patient an unknown drug via IV.
- D. is not the patient's designated healthcare surrogate.
Answer: C
Explanation:
According to Health Care Risk Management standards supported by ASHRM, CMS Conditions of Participation, and The Joint Commission patient visitation standards, hospitals must have written visitation policies that respect patient rights. Patients generally have the right to designate visitors of their choosing, including individuals who are not immediate family members. Visitation cannot be restricted based on non- clinical factors such as relationship status or surrogate designation.
However, facilities may impose clinically reasonable or safety-based restrictions. If a visitor administers an unknown drug intravenously to a patient, this presents a clear and immediate threat to patient safety. Such conduct justifies restricting visitation to protect the patient from harm, maintain clinical control of treatment, and prevent unsafe interference with care.
Being known as a drug seeker in the community, without evidence of disruptive or harmful behavior during the visit, does not alone justify restriction under patient rights standards. Similarly, visitation cannot be denied solely because the individual is not the designated healthcare surrogate.
Legal and regulatory objectives emphasize balancing patient rights with safety and security. Therefore, a hospital may restrict visitation when a visitor's actions pose a direct threat to patient safety.
NEW QUESTION # 43
An interrogatory requests insurance policy information. A risk manager should
- A. provide excess limits as well as primary limits.
- B. object to the interrogatory.
- C. attach a certificate of insurance.
- D. provide the specifically requested information.
Answer: D
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, insurance policy information is generally discoverable in litigation. Most jurisdictions require disclosure of applicable liability coverage, including policy limits, pursuant to civil procedure rules governing discovery. Therefore, when an interrogatory properly requests insurance policy information, the organization should provide the specifically requested information in coordination with defense counsel.
Providing more information than requested, such as automatically including excess limits if not asked, may exceed the scope of the interrogatory and should be guided by legal counsel. A certificate of insurance is not a substitute for responding to formal discovery requests, as it may not contain all required details regarding coverage, limits, and applicable policy periods.
Objecting to the interrogatory without valid legal grounds is generally inappropriate, as insurance coverage information is typically relevant to potential satisfaction of judgment.
Claims and litigation objectives emphasize cooperation with counsel, compliance with discovery rules, and accurate disclosure of coverage information. Therefore, the appropriate response is to provide the specifically requested insurance policy information in accordance with legal guidance.
NEW QUESTION # 44
A hospital risk manager has been called to the Neonatal Intensive Care Unit to discuss a 25-week premature infant whose parents are refusing a planned blood transfusion due to their religious beliefs. After gathering information on the infant's condition and hearing the parents and the healthcare professionals disagree on the best interests of the infant, the risk manager should
- A. contact legal counsel to arrange for an emergency court hearing to obtain a court order from the state to intervene.
- B. arrange for an ethics committee consultation to meet the parents and discuss the issue.
- C. prohibit the blood transfusion, respecting the parents' rights as substitute decision-makers for the infant.
- D. advise the care team to proceed with the blood transfusion.
Answer: A
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, while parents generally serve as surrogate decision-makers for minors, their authority is not absolute. When refusal of treatment places a child at significant risk of serious harm or death, healthcare providers have an ethical and legal obligation to act in the best interests of the child.
In cases involving life-sustaining treatment for a premature infant, refusal of a medically necessary blood transfusion may constitute potential medical neglect if it threatens the infant's survival. When disagreement persists after appropriate communication and ethics consultation, and the infant's life is at risk, the appropriate step is to seek judicial intervention. Contacting legal counsel to obtain an emergency court order allows the state to exercise its parens patriae authority to protect the child's welfare.
An ethics consultation may help clarify values and promote dialogue but does not override urgent medical necessity. Simply prohibiting or proceeding without legal authority exposes the organization to liability.
Legal and regulatory objectives emphasize protecting vulnerable patients while respecting due process.
Therefore, seeking an emergency court order through legal counsel is the appropriate action.
NEW QUESTION # 45
Which of the following should prompt a risk manager to give notice to a malpractice carrier?
- A. written medical record request from an attorney
- B. internal incident report
- C. demand letter from a patient
- D. disclosure to a patient
Answer: C
Explanation:
Under Health Care Risk Management principles established by ASHRM and the American Hospital Association Certification Center, timely notice to a malpractice carrier is a critical obligation, particularly under claims-made policies. A demand letter from a patient constitutes a clear assertion of liability and a request for compensation, which typically meets the definition of a claim under most malpractice insurance policies. Failure to notify the carrier promptly may jeopardize coverage.
A written medical record request from an attorney may signal potential litigation, but it does not necessarily constitute a claim unless accompanied by an allegation of wrongdoing or a demand for damages. An internal incident report is a risk management tool used for quality and safety improvement and does not itself trigger insurance notification requirements. Similarly, disclosure to a patient regarding an adverse event aligns with transparency practices but does not automatically represent a formal claim.
Risk management objectives emphasize understanding policy language, particularly definitions of claim and reporting requirements. Because a demand letter explicitly alleges harm and seeks compensation, it most clearly triggers the duty to notify the malpractice carrier to preserve coverage and initiate appropriate claims handling procedures.
NEW QUESTION # 46
What are the four elements of the SBAR situational briefing model?
- A. Summary, Background, Action, Review
- B. Situation, Background, Assessment, Recommendation
- C. Situation, Behavior, Action, Result
- D. Scene, Background, Assessment, Response
Answer: B
Explanation:
SBAR is a standardized communication framework used to reduce preventable harm caused by incomplete, unclear, or delayed clinical communication-especially during handoffs, escalations, and urgent updates. The four elements areSituation(what is happening now),Background(clinical context and relevant history), Assessment(what you think the problem is based on data), andRecommendation(what you need/request as the next step). By forcing concise structure, SBAR improves shared situational awareness, supports early recognition of deterioration, and reduces ambiguity ("hinting and hoping"). From a risk management standpoint, SBAR strengthens frontline reliability, decreases communication-related sentinel events, and supports defensible care by demonstrating a consistent escalation process. It also aligns with patient safety objectives: clearer teamwork, faster response to clinical changes, and fewer omissions during transitions of care.
NEW QUESTION # 47
A 78-year-old patient in the ICU is unable to speak or swallow. The physician states that she is terminally ill and believes she lacks decision-making capacity. As such, he has deferred to her properly executed advance directive that clearly outlines her wishes for no life-prolonging treatment. The patient's three sons know of the directive, but insist that a PEG tube be placed to assist with feeding. The physician is opposed to placing the tube. The nurse calls the risk manager for advice. Which of the following should the risk manager advise?
- A. The patient has the right to autonomy, and the advance directive is proper; support the physician.
- B. More facts are needed; request an ethics consultation.
- C. The family will outlive the patient, and they have the right to sue; support the family.
- D. More facts are needed; decision making capacity must be determined before moving forward.
Answer: A
Explanation:
Under Health Care Risk Management principles recognized by ASHRM and the American Hospital Association Certification Center, a properly executed advance directive carries legal authority when a patient lacks decision-making capacity. The physician has assessed that the patient is terminally ill and lacks capacity, triggering activation of the advance directive. If the directive clearly states refusal of life-prolonging treatment, including artificial nutrition and hydration, those wishes must be honored in accordance with state law and the Patient Self-Determination Act framework.
Patient autonomy is a foundational ethical and legal principle in health care. Once capacity is lost, previously expressed wishes through a valid advance directive govern care decisions. Family members do not have authority to override a valid directive unless legal defects or ambiguity exist. Their disagreement does not negate the patient's documented preferences.
Although ethics consultation can be helpful in managing conflict, the directive here is described as properly executed and clear. Additional determination of capacity is unnecessary because the physician has already made that assessment.
Risk management objectives emphasize compliance with advance directive statutes, respect for patient autonomy, and reduction of liability through adherence to documented patient wishes. Therefore, the appropriate advice is to support the physician in honoring the advance directive.
NEW QUESTION # 48
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