Question

A review of individual cases by a committee to make sure that services are medically necessary is called a(n):

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

Answer 1

The process in which a committee reviews individual cases to ensure medically necessary services is called a utilization review, significant in managing health care resources and costs.

Step-by-step explanation:

The review of individual cases by a committee to ensure that services are medically necessary is called a utilization review. This process is particularly critical in health maintenance organizations (HMOs) and fee-for-service systems, where it helps in managing the allocation of resources and controlling the costs of treatments, while also addressing concerns such as adverse selection. The utilization review evaluates the necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities.