In a managed health care plan, the process in which the utilization review organization reviews the necessity and quality of the medical care an insured received in a hospital following the hospitalization. See also managed health care plan and utilization review (UR).
After-treatment monitoring of utilization patterns against objective medical norms to detect inappropriate care (too little or too much) or excess cost. This is a component of utilization management.
A component of a utilization review program that provides an insurer with periodic reports on physicians' practice patterns and hospitals' average lengths-of-stay.----------[ Back