The process by which one assesses the medical necessity of a patient's need for continuation of inpatient care or to continue a cycle of ongoing ambulatory or ancillary services.
A case management technique which allows insurance companies to monitor an insured's hospital stay and to know in advance if there are any changes in the expected period of confinement and the planned release date.
A component of a utilization review program that monitors an insured's care while the insured is hospitalized and encourages the dismissal of an insured from the hospital as soon as the insured's medical condition no longer warrants continued in-patient care.----------[ Back
A routine review by an internal or external utilization reviewer during the course of a patient's treatment to determine if continued treatment is medically necessary.
Review conducted during the course of a patient’s hospital stay or course of treatment, to determine whether the hospital stay or treatment is still necessary. NCGS 58-50-61(a)(17)(d).
A screening method by which a health care provider reviews a procedure performed or hospital admission authorized by a colleague to assess its necessity.
Concurrent review is a utilization management function performed by registered nurses on each inpatient admission to acute care hospitals or extended care facilities. The concurrent review process determines the appropriateness of the hospital stay and level of care. And is based on standardized review criteria.
Review of the medical necessity of hospital or other health facility admissions upon or within a short period following an admission and the periodic review of services provide during the course of treatment. The initial review assigns an appropriate length of stay to the admission (using diagnosis specific criteria), which may also be reassessed periodically. Where concurrent review is required, payment for unneeded hospitalizations or services is usually denied.
A form of utilization review in which hospital admissions are reviewed and certified within 24 hours of admission, and are monitored for appropriateness thereafter.
The review of continued-stay hospital cases and discharge-planning efforts to ensure proper and efficient placement of the hospital patient.
A kind of utilization review using predetermined patient placement criteria, conducted while the consumer is receiving services to determine whether the care being delivered is medically necessary or appropriate, and eligible for payment; performed either by an internal or external reviewer.
Utilization review conducted during a patient's hospital stay or course of treatment. See utilization review.
A review of patient care while the patient is still in the hospital to determine the medical necessity for the treatment and the length of stay. See also admission certification.
The process by which health services are reviewed to determine appropriateness; the review is conducted at the same time the services are provided.
Certifies continuing inpatient days for a claimant. Typically initiated by the provider (hospital/doctor) and reviewed/certified by the UR Vendor, Case Manager, or HCC Life Medical Staff.
Review of a procedure or hospital admission done by health care professional (usually a nurse) other than the one providing your care. Concurrent review is conducted during a hospital stay to determine the appropriateness of the confinement and the medical necessity for a continued stay.
A component of utilization review used by some health insurers whereby the utilization review organization monitors an insured's treatment and prognosis while he is in the hospital. See also utilization review.