What Is Utilization Review?

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https://www.youtube.com/watch?v=6F0bHlDBSEk

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Ash Collignon

Estados Unidos

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What Is Utilization Review?


What Is Utilization Review?Versión en línea https://www.youtube.com/watch?v=6F0bHlDBSEk por Ash Collignon 1 What is the main goal of Utilization Review? a To diagnose medical conditions b To reduce hospital staff c To control health care costs and improve patient care d To advertise insurance policies 2 Which of the following is not a type of utilization review mentioned in the video? a Prospective b Predictive c Concurrent d Retrospective 3 What is the purpose of a retrospective review? a To decide future treatment plans b To check the billing codes c To evaluate care after it's provided d To cancel unnecessary surgeries 4 Who typically performs utilization reviews? a Lawyers and accountants b Patients and caregivers c Customer service representatives d Nurses and physicians 5 What are possible outcomes of the utilization review decision-making process? a Only approval b Approval, modification, or denial c Jail time for fraud d Automatic approval of all requests 6 What does utilization review help prevent? a Unnecessary treatments b Good care c High-quality treatment d Patient communication 7 If a provider calls to request approval for a procedure before the patient receives treatment, which part of the Care Management team handles this, and what type of review is it? a Financial Advocates; Retrospective Review b Nurses; Prospective (Pre-Determination) Review c Head Nurse Case Manager; Predictive Review d Clerks; Concurrent Review 8 Which of the following best reflects why utilization review and financial advocacy are both important parts of the Care Management process? a One approves services and the other handles claims b Utilization review is for members, and advocacy is for providers c They both help members get more expensive services d Together, they ensure care is both medically necessary and financially accessible. 9 A provider is calling in during a member’s ongoing inpatient stay to extend the hospital days due to complications. What kind of review is this, and what must be considered when processing the request? a Prospective Review; cost only b Financial Advocacy; patient ability to pay c Retrospective Review; billing codes d Concurrent Review; real-time medical necessity and updated clinicals 10 Why is it important for you to understand utilization review and the role of the Care Management team, even if you’re not the one making clinical decisions? a Because the more informed you are, the better you can guide providers, set expectations, and explain the process b To give medical advice directly to members and providers c So you can approve services without asking a nurse d It's not important — Care Management handles everything anyway

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What Is Utilization Review?

Video Quiz

Sobre esta actividad

Creada por

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What Is Utilization Review?Versión en línea

por Ash Collignon

What is the main goal of Utilization Review?

Which of the following is not a type of utilization review mentioned in the video?

What is the purpose of a retrospective review?

Who typically performs utilization reviews?

What are possible outcomes of the utilization review decision-making process?

What does utilization review help prevent?

If a provider calls to request approval for a procedure before the patient receives treatment, which part of the Care Management team handles this, and what type of review is it?

Which of the following best reflects why utilization review and financial advocacy are both important parts of the Care Management process?

A provider is calling in during a member’s ongoing inpatient stay to extend the hospital days due to complications. What kind of review is this, and what must be considered when processing the request?

Why is it important for you to understand utilization review and the role of the Care Management team, even if you’re not the one making clinical decisions?