Chapter 5: Managed Care Activities: Utilization Review

Question 1

Utilization review is a method of?

Answer 1

Controlling health care cost by focusing only on what is necessary =.

Question 2

The benefits, efficiency, and medical necessity of the health care provided to patients are reviewed on?

Answer 2

A prospective, concurrent and retrospective basis.

Question 3

A prospective review assesses the need for health care services before what?

Answer 3

Before the service is performed.

Question 4

Providers must often submit preauthorizations to health plans under?

Answer 4

Utilization review process.

Question 5

For concurrent reviews, services are reviewed as they are being?

Answer 5

Provided during the hospitalization.

Question 6

Who focuses on the coordination of care, the appropriateness of the length of stay, and discharge planning?

Answer 6

The nurse reviewer.

Question 7

What is the process of assessing the appropriateness of health care services after care has been provided?

Answer 7

Retrospective Review.

Question 8

What does hospitals have to perform retrospective reviews to ensure claim submissions contain complete and correct medical codes for all services provided?

Answer 8

A certified coder.