Which utilization review happens after care?

Which utilization review happens after care?

• A. Before care; includes prior authorization
• B. During care; includes discharge planning
• C. During care; price review
• D. After care; evaluates necessity and appropriateness

Answer: (D)

Utilization review after care is retrospective, done once the patient has received services. Its main aim is to determine whether the care provided was medically necessary and appropriate for the diagnosed condition, and whether it aligned with guidelines, was billed correctly, and used resources appropriately. This post-care evaluation helps with payment decisions and informs quality improvement efforts. In contrast, reviews conducted before care (prospective) involve authorization and planning, while reviews conducted during care (concurrent) monitor ongoing treatment and discharge planning.

Utilization review after care is retrospective, done once the patient has received services. Its main aim is to determine whether the care provided was medically necessary and appropriate for the diagnosed condition, and whether it aligned with guidelines, was billed correctly, and used resources appropriately. This post-care evaluation helps with payment decisions and informs quality improvement efforts. In contrast, reviews conducted before care (prospective) involve authorization and planning, while reviews conducted during care (concurrent) monitor ongoing treatment and discharge planning.