HCA 468 QUIZ 5 QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026
Establishing the Claims File, usually the file jacket or folder contains basic identification information
on the claim (e. g., claimant's name, claim number. The form should contain the following data: Date
of incident, Date of claim, Allegation, Claim number, Date file opened, Date file closed, Current status,
Changes in reserves ( indemnity and expense), Plaintiff's name, Defendant's name, Name of plaintiff's
attorney, Name of defense attorney, Department Location, Diary date, Disposition of case - Answers
true
Establishing the Claims File, a checklist that details elements of the initial investigation should include:
Equipment Incidents that contains: name, address, telephone number, medical staff or employment
status, specialty, involvement in case, and insurance information (policy number, policy period, limits)
- Answers false
Establishing the Claims File, the checklist that details elements of the initial investigation should
include: The Claimant information that contains: name, date of birth, gender, address, telephone
number, marital status, occupation, employer, income, dependents, and other relevant social factors
- Answers true
Under the Risk Identification Systems, the risk or claims manager should educate non- clinical
departments in the importance of providing information regarding potentially compensable events.
Managers can extend beyond traditional sources to ensure prompt identification of these incidents.
Which of the following departments are able to provide early- warning indicators? (answer all of the
above) - Answers a)
The medical records department can advise the claims management office of requests for records by
plaintiffs' attorneys
b)
The quality management department can provide information from generic screening criteria and
other medical-staff sources, as applicable
c)
Billing offices can notify the claims office of serious medical care complaints when following up on
delinquent bills
d)
Volunteer services and patient relations departments can relay complaints about patient care.
Volunteers are often the first to hear from disgruntled patients, because they are often viewed by the
patients as neutral.
Establishing the Claims File, the body of the file should be organized and filed in chronological order.
The following information should include (anser all of the above) - Answers Incident report or other
source of information
Date the incident occurred and date reported to the claims- management department
Date reported to insurer and attorney (as applicable)
How the information was reported
Establishing the Claims File, the summary saves lengthy reviews of the entire file by providing a brief
synopsis of the following items: Pertinent points from the record of the clinical course, Claimants,
Possible defendants, Allegation, Legal status, Deviations from standard of care, Plaintiff's counsel,
Defense counsel, Witness testimony, Demand, Comments, Future activity - Answers true
Under the Program Development, the information received from all sources should be logged into the
system upon receipt. The information the log should include is - Answers all of the above
Which of the following define Lawsuit Losses? - Answers a)
Once a lawsuit is filed, the healthcare defendant must consider the merits of the suit within the
context of its litigation. At this early litigation stage, risk managers, the product of their investigations,
and their organizational knowledge may play a critical role
b)
Reliable and thorough pre-suit investigation provides valuable insight into a defendant's response if
the investigated matter becomes a lawsuit. For those matters not investigated at the pre- suit stage,
defendants' lawsuit response is determined by their litigation
Under the Quality-Improvement Documents, some examples of materials that are protected from
disclosure include - Answers all of the above
A spoliation action seeks damages not for negligent medical care, but for a breach of the duty to
preserve medical evidence - Answers true
Establishing the Claims File, usually the file jacket or folder contains basic identification information
on the claim (e. g., claimant's name, claim number. The form should contain the following data: Date
of incident, Date of claim, Allegation, Claim number, Date file opened, Date file closed, Current status,
Changes in reserves ( indemnity and expense), Plaintiff's name, Defendant's name, Name of plaintiff's
attorney, Name of defense attorney, Department Location, Diary date, Disposition of case - Answers
true
Establishing the Claims File, a checklist that details elements of the initial investigation should include:
Equipment Incidents that contains: name, address, telephone number, medical staff or employment
status, specialty, involvement in case, and insurance information (policy number, policy period, limits)
- Answers false
Establishing the Claims File, the checklist that details elements of the initial investigation should
include: The Claimant information that contains: name, date of birth, gender, address, telephone
number, marital status, occupation, employer, income, dependents, and other relevant social factors
- Answers true
Under the Risk Identification Systems, the risk or claims manager should educate non- clinical
departments in the importance of providing information regarding potentially compensable events.
Managers can extend beyond traditional sources to ensure prompt identification of these incidents.
Which of the following departments are able to provide early- warning indicators? (answer all of the
above) - Answers a)
The medical records department can advise the claims management office of requests for records by
plaintiffs' attorneys
b)
The quality management department can provide information from generic screening criteria and
other medical-staff sources, as applicable
c)
Billing offices can notify the claims office of serious medical care complaints when following up on
delinquent bills
d)
Volunteer services and patient relations departments can relay complaints about patient care.
Volunteers are often the first to hear from disgruntled patients, because they are often viewed by the
patients as neutral.
Establishing the Claims File, the body of the file should be organized and filed in chronological order.
The following information should include (anser all of the above) - Answers Incident report or other
source of information
Date the incident occurred and date reported to the claims- management department
Date reported to insurer and attorney (as applicable)
How the information was reported
Establishing the Claims File, the summary saves lengthy reviews of the entire file by providing a brief
synopsis of the following items: Pertinent points from the record of the clinical course, Claimants,
Possible defendants, Allegation, Legal status, Deviations from standard of care, Plaintiff's counsel,
Defense counsel, Witness testimony, Demand, Comments, Future activity - Answers true
Under the Program Development, the information received from all sources should be logged into the
system upon receipt. The information the log should include is - Answers all of the above
Which of the following define Lawsuit Losses? - Answers a)
Once a lawsuit is filed, the healthcare defendant must consider the merits of the suit within the
context of its litigation. At this early litigation stage, risk managers, the product of their investigations,
and their organizational knowledge may play a critical role
b)
Reliable and thorough pre-suit investigation provides valuable insight into a defendant's response if
the investigated matter becomes a lawsuit. For those matters not investigated at the pre- suit stage,
defendants' lawsuit response is determined by their litigation
Under the Quality-Improvement Documents, some examples of materials that are protected from
disclosure include - Answers all of the above
A spoliation action seeks damages not for negligent medical care, but for a breach of the duty to
preserve medical evidence - Answers true
