Utilization Review (UR) is defined as:

Utilization Review (UR) is defined as:

• A. The process of reviewing medical care in individual cases to ensure services are medically necessary and resources are used appropriately; performed by medical peers and used as a cost control measure by managed care organizations.
• B. A method for auditing patient charts only after discharge.
• C. A policy decision made by the hospital administration.
• D. A method to determine staff vacation schedules.

Answer: (C)

Utilization Review is the process of evaluating medical care in individual cases to ensure services are medically necessary and resources are used appropriately, typically performed by medical peers and used as a cost-control measure by managed care organizations. This is more than just auditing charts after discharge; UR involves assessing the necessity and appropriateness of care while it’s happening or near the point of care, often to prevent unnecessary tests or extended stays. It’s not about hospital administrative policy decisions or staff vacation scheduling.

Utilization Review is the process of evaluating medical care in individual cases to ensure services are medically necessary and resources are used appropriately, typically performed by medical peers and used as a cost-control measure by managed care organizations. This is more than just auditing charts after discharge; UR involves assessing the necessity and appropriateness of care while it’s happening or near the point of care, often to prevent unnecessary tests or extended stays. It’s not about hospital administrative policy decisions or staff vacation scheduling.