Utilization management
Utilization Management
Utilization Management (pronounced: yoo-til-i-zay-shun man-ij-muhnt) is a healthcare practice used to ensure that all treatments and medical services are appropriate, necessary, and efficient.
Etymology
The term "Utilization Management" is derived from the English words "utilization," which means the action of using something, and "management," which refers to the process of dealing with or controlling things or people.
Definition
Utilization Management is a method used by health insurance companies and healthcare providers to evaluate the necessity, appropriateness, and efficiency of healthcare services. The goal of Utilization Management is to ensure that patients receive the most appropriate care in the most appropriate setting.
Process
The Utilization Management process involves pre-authorization of procedures, concurrent review of ongoing care, and post-service review. This process is designed to ensure that patients receive necessary care without unnecessary costs.
Related Terms
- Pre-Authorization: The process of getting an agreement from the insurer to cover specific medical services before those services are rendered.
- Concurrent Review: An assessment that takes place during a patient's stay in a hospital or other healthcare facility to ensure that the care being provided is necessary and appropriate.
- Post-Service Review: A review that occurs after medical services have been provided to evaluate the appropriateness of the care and the accuracy of the billing.
- Healthcare Provider: A person or organization that provides health care services.
- Health Insurance: A type of insurance coverage that pays for medical and surgical expenses incurred by the insured.
External links
- Medical encyclopedia article on Utilization management
- Wikipedia's article - Utilization management
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