CPHRM Exam Prep - Claims and
Litigation Questions And Answers |
Verified
Adverse Event CORRECT ANSWERS Any injury (undesirable clinical outcome) caused
by medical care and not an underlying disease process.
Adverse Outcome CORRECT ANSWERS Clinical outcome that, while neither desirable
nor necessarily anticipated, may still have been a known possibility associated with the
treatment or procedure.
Alternative Dispute Resolution CORRECT ANSWERS A process or system to resolve
disputes outside the formal judicial process.
Negotiation CORRECT ANSWERS A voluntary, usually informal, unstructured process.
There is no third party facilitator but parties may be represented by legal counsel.
(BETWEEN TWO PARTIES ONLY).
Mediation CORRECT ANSWERS A process in which a neutral third party helps the
parties reach a mutually acceptable agreement. (Two parties select an agreed upon
person to mediate).
Arbitration CORRECT ANSWERS The hearing and determination of a case in question
someone either chosen by the opposing parties or by a person appointed under
statutory authority.
Binding Arbitration CORRECT ANSWERS An agreement that is final and not
appealable.
Non-Binding Arbitration CORRECT ANSWERS An agreement is not final until it is
entered by the court into the record allowing the party to continue the civil litigation
process.
Answer CORRECT ANSWERS A document filed with the court in response to a
complaint or petition. Generally the answer must admit that plaintiff's allegations are
true; deny that the plaintiff's allegations are true; or state that the defendant does not
have information regarding the truth or falsity of the allegations.
Appeal CORRECT ANSWERS An action that is taken after the trial of a matter or after a
dispositive motion has been entered in the matter. An appeal may be taken for the
purpose of correcting an error made by the trial court or to obtain a new trial. Also, it is a
resort to a higher court to obtain a review of a lower court's decision and a reversal of
the lower court's judgment or granting of anew trial.
, Assault CORRECT ANSWERS An intentional act that is designed to make the victim
fearful and that produces reasonable apprehension of harm.
Attorney-Client Privilege CORRECT ANSWERS A legal doctrine recognized by both
common and statutory law protecting certain confidential communications between an
attorney and his or her client from discovery in a legal proceeding unless the privilege is
waived by the client.
Attorney Work Product Privilege CORRECT ANSWERS A legal doctrine recognized by
both common and statutory law protecting the documents generated, theories devised,
legal strategies formulated, etc. by an attorney on behalf of a client from discovery in a
legal proceeding unless the privilege is waived by the client.
Battery CORRECT ANSWERS In tort law, the intentional causation of harmful or
offensive contact with a person without that person's consent.
Claim CORRECT ANSWERS Formal notification, either in writing or orally that
monetary damages or demand for services are being sought from the healthcare
organization by a third party for an alleged injury. Can be made by patient, or patient's
family, guardian, or attorney.
Claims-Made Coverage CORRECT ANSWERS Provides coverage for a claim that
occurred AFTER the inception or retroactive coverage date of the policy and is reported
to the insurance company while the policy or any replacement policy is still in effect.
Complaint/Grievance CORRECT ANSWERS A formal or informal written or verbal
complaint made to the hospital by the patient or the patient's representative regarding
the patient's care. Medicare/Medicaid Hospital Conditions of Participation require a
formal process for patient notification of their rights and for response and follow up with
the patient.
Complaint (Legal) CORRECT ANSWERS One of the initial filings with the court to begin
a lawsuit; normally recites all of the allegations against the defendant and theories upon
which the plaintiff seeks to recover damages (may be called a petition in some
jurisdictions).
Damages CORRECT ANSWERS Monetary compensation obtained for an injury for
which the plaintiff (claimant) seeks compensation from the defendant (healthcare
provider) and may include economic losses, emotional distress, pain and suffering and
disability.
Punitive or Exemplary CORRECT ANSWERS Damages sought or awarded to punish or
deter a defendant or others from similar conduct rather than to compensate the injured
party. The awarding of punitive damages generally requires a showing of gross
Litigation Questions And Answers |
Verified
Adverse Event CORRECT ANSWERS Any injury (undesirable clinical outcome) caused
by medical care and not an underlying disease process.
Adverse Outcome CORRECT ANSWERS Clinical outcome that, while neither desirable
nor necessarily anticipated, may still have been a known possibility associated with the
treatment or procedure.
Alternative Dispute Resolution CORRECT ANSWERS A process or system to resolve
disputes outside the formal judicial process.
Negotiation CORRECT ANSWERS A voluntary, usually informal, unstructured process.
There is no third party facilitator but parties may be represented by legal counsel.
(BETWEEN TWO PARTIES ONLY).
Mediation CORRECT ANSWERS A process in which a neutral third party helps the
parties reach a mutually acceptable agreement. (Two parties select an agreed upon
person to mediate).
Arbitration CORRECT ANSWERS The hearing and determination of a case in question
someone either chosen by the opposing parties or by a person appointed under
statutory authority.
Binding Arbitration CORRECT ANSWERS An agreement that is final and not
appealable.
Non-Binding Arbitration CORRECT ANSWERS An agreement is not final until it is
entered by the court into the record allowing the party to continue the civil litigation
process.
Answer CORRECT ANSWERS A document filed with the court in response to a
complaint or petition. Generally the answer must admit that plaintiff's allegations are
true; deny that the plaintiff's allegations are true; or state that the defendant does not
have information regarding the truth or falsity of the allegations.
Appeal CORRECT ANSWERS An action that is taken after the trial of a matter or after a
dispositive motion has been entered in the matter. An appeal may be taken for the
purpose of correcting an error made by the trial court or to obtain a new trial. Also, it is a
resort to a higher court to obtain a review of a lower court's decision and a reversal of
the lower court's judgment or granting of anew trial.
, Assault CORRECT ANSWERS An intentional act that is designed to make the victim
fearful and that produces reasonable apprehension of harm.
Attorney-Client Privilege CORRECT ANSWERS A legal doctrine recognized by both
common and statutory law protecting certain confidential communications between an
attorney and his or her client from discovery in a legal proceeding unless the privilege is
waived by the client.
Attorney Work Product Privilege CORRECT ANSWERS A legal doctrine recognized by
both common and statutory law protecting the documents generated, theories devised,
legal strategies formulated, etc. by an attorney on behalf of a client from discovery in a
legal proceeding unless the privilege is waived by the client.
Battery CORRECT ANSWERS In tort law, the intentional causation of harmful or
offensive contact with a person without that person's consent.
Claim CORRECT ANSWERS Formal notification, either in writing or orally that
monetary damages or demand for services are being sought from the healthcare
organization by a third party for an alleged injury. Can be made by patient, or patient's
family, guardian, or attorney.
Claims-Made Coverage CORRECT ANSWERS Provides coverage for a claim that
occurred AFTER the inception or retroactive coverage date of the policy and is reported
to the insurance company while the policy or any replacement policy is still in effect.
Complaint/Grievance CORRECT ANSWERS A formal or informal written or verbal
complaint made to the hospital by the patient or the patient's representative regarding
the patient's care. Medicare/Medicaid Hospital Conditions of Participation require a
formal process for patient notification of their rights and for response and follow up with
the patient.
Complaint (Legal) CORRECT ANSWERS One of the initial filings with the court to begin
a lawsuit; normally recites all of the allegations against the defendant and theories upon
which the plaintiff seeks to recover damages (may be called a petition in some
jurisdictions).
Damages CORRECT ANSWERS Monetary compensation obtained for an injury for
which the plaintiff (claimant) seeks compensation from the defendant (healthcare
provider) and may include economic losses, emotional distress, pain and suffering and
disability.
Punitive or Exemplary CORRECT ANSWERS Damages sought or awarded to punish or
deter a defendant or others from similar conduct rather than to compensate the injured
party. The awarding of punitive damages generally requires a showing of gross
