CPHRM flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Discovery rule

A doctrine that delays accrual of the statute of limitations until the patient knew or reasonably should have known of the injury and its negligent cause.

Res ipsa loquitur

A doctrine allowing an inference of negligence when the injury would not ordinarily occur without negligence and the instrumentality causing it was in the defendant's exclusive control.

Certificate of merit

A pre-suit filing required in some states in which a qualified expert attests that the case has a reasonable basis in fact and merits further review.

Claims-made policy trigger

Coverage applies only when a claim is first made and reported during the policy period, provided the alleged act occurred on or after the retroactive date.

Extended reporting period

A tail endorsement purchased on a claims-made policy that permits reporting of claims after the policy expires for acts that occurred during the policy period.

National Practitioner Data Bank

A federal repository of malpractice payments and adverse licensure or clinical privileging actions that hospitals must query during initial credentialing and reappointment.

Negligent credentialing

A corporate liability theory holding a hospital responsible for failing to reasonably investigate and verify a practitioner's qualifications before granting or renewing privileges.

Sentinel event

A Joint Commission-defined unexpected occurrence involving death, permanent harm, or severe temporary harm requiring intervention to sustain life, triggering a root cause analysis within 45 days.

Root cause analysis

A structured retrospective team review identifying the systems and process failures that contributed to an adverse event, producing an action plan with measurable outcome monitoring.

Just culture

A framework that separates human error, at-risk behavior, and reckless behavior so that organizational response matches the behavior rather than the severity of the outcome.

Failure Mode and Effects Analysis

A prospective team method that identifies how a process could fail and ranks risks by severity times occurrence times detection to prioritize redesign efforts.

Universal Protocol

A three-part pre-procedure safety process consisting of verification of the patient and procedure, marking of the site, and a team time-out before the procedure begins.

High-alert medication

A drug with heightened risk of substantial patient harm when used in error, such as insulin, heparin, opioids, and concentrated electrolytes, requiring standardized storage and independent double checks.

EMTALA

A federal law requiring Medicare-participating hospitals with emergency departments to provide a medical screening examination and stabilizing treatment regardless of insurance status or ability to pay.

Primary source verification

Credentialing confirmation of licensure, education, training, and board certification obtained directly from the issuing authority rather than from the applicant or a secondary database.

HCAHPS

A standardized, publicly reported survey of hospitalized patients' experience of care whose results adjust hospital payment through the value-based purchasing program.

Plan of correction

A hospital's written response to cited survey deficiencies stating the corrective action, the individual responsible, and the completion date, subject to resurvey verification.

Never event

A serious, clearly identifiable, and largely preventable patient harm event, such as wrong-site surgery or a retained foreign body, that is reportable and generally non-reimbursable.

Value-based purchasing

A CMS program that increases or decreases inpatient hospital payment based on performance in clinical outcomes, patient safety, cost efficiency, and patient experience domains.

HIPAA breach notification

Covered entities must notify affected individuals within 60 days of discovering a breach, and notify HHS and media when 500 or more individuals are affected.

Minimum necessary standard

A HIPAA requirement limiting routine uses, disclosures, and requests of protected health information to the least amount reasonably needed to accomplish the intended purpose.

Anti-Kickback Statute

A criminal, intent-based federal law prohibiting remuneration offered or received to induce referrals of items or services reimbursable by federal health care programs, subject to regulatory safe harbors.

Stark Law

A strict-liability civil statute prohibiting physician referrals of designated health services to entities with which the physician or an immediate family member has a financial relationship, absent an exception.

False Claims Act

A statute imposing treble damages and per-claim civil penalties for knowingly submitting false claims to federal programs, with qui tam relators eligible for a share of the recovery.

Patient Safety Work Product

Information assembled for reporting to a patient safety organization that is privileged and confidential under PSQIA, excluding original medical records and legally required reports.

Self-insured retention

A per-claim amount the organization pays before coverage responds, within which the organization typically also bears defense costs and the insurer has no duty to defend.

Captive insurance company

A licensed insurer owned by one or more non-insurance organizations to finance their own retained risks, subject to state capitalization, solvency, and reporting requirements.

Retroactive date

The earliest date on which a covered act may have occurred under a claims-made policy; acts performed before that date are excluded from coverage.

Incurred but not reported

An actuarial estimate of liability for claims that have occurred but have not yet been reported to the insurer, recorded as a reserve on the organization's books.

Cost of risk

The total cost of an organization's risk program, comprising insurance premiums, retained losses, claims administration, and loss control spending.

Law of large numbers

The principle that actual loss experience converges toward expected losses as the number of independent, similar exposure units increases, supporting higher retention levels.

Loss run

A carrier or third-party administrator report of an organization's historical claims showing paid amounts, reserves, and status by policy year, used for renewal pricing.