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Managed Care Nursing

Category - Healthcare Management

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A retrospective utilization review is best described as:

The process used to assess the relevancy of medical treatment during an inpatient stay
The process used to determine if care or medical treatment is necessary based on individual instances
A review post discharge of health records and claims to assess quality of care and medical necessity

Explanation

Answer: C - Retrospective utilization review is a review post discharge of health records and claims to assess quality of care and medical necessity.

There is a difference in how the chart is reviewed during routine utilization versus retrospective review along with learning gained for future management.

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Managed Care Nursing

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Managed Care Nursing

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