Utilization Review
A systematic evaluation of medical services to ensure appropriate use of healthcare resources and quality care.
Full Definition
Utilization review is a quality assurance process that evaluates the necessity, appropriateness, and efficiency of psychiatric services, treatments, and hospital stays. In mental health settings, this includes reviewing admission criteria, length of stay, treatment intensity, and discharge planning. The process involves clinical staff reviewing cases against established criteria and guidelines to ensure patients receive the right level of care. Insurance companies, hospitals, and regulatory bodies conduct utilization reviews to control costs while maintaining quality standards. Documentation must support medical necessity and demonstrate progress toward treatment goals.
Usage
Usage note: Can be abbreviated as 'UR' in internal documents; spell out in formal reports.
In Context
- "The utilization review committee determined that continued inpatient stay was medically necessary due to ongoing safety concerns." — hospital committee report
- "Documentation must clearly support medical necessity to pass utilization review requirements." — clinical documentation guidelines