Question

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called?

1) Medical audit
2) Utilization review
3) Quality improvement
4) Case management

Answer 1

The process carried out by a committee to ensure services are medically necessary and resources are used efficiently is called Utilization review.

Step-by-step explanation:

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a Utilization review. This process involves assessing the appropriateness, necessity, and efficiency of the use of healthcare services, procedures, and facilities. In the context of health maintenance organizations (HMOs) or fee-for-service systems, utilization review is critical in balancing the cost of services, patient care, and the allocation of resources. The committee carries out this review to ensure that medical services are not overused or misused, thereby controlling costs and maintaining quality of care.