utilization review

u·til·i·za·tion review (ytl--zshn)

n.

A process for monitoring the use, delivery, and cost-effectiveness of services, especially those provided by medical professionals.

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utilization review (UR)

[yo̅o̅′tilīzā′shən]

Etymology: L, utilis + atus, process

an assessment of the appropriateness and economy of an admission to a health care facility or a continued hospitalization. The length of the hospital stay also is compared with the average length of stay for similar diagnoses.

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utilization,

n 1. the extent to which a given group uses a particular service in a specified period. Although usually expressed as the number of services used per year per 100 or per 1000 persons eligible for the service, utilization rates may be expressed in other ratios.
2. the extent to which the members of a covered group use a program over a stated time, specifically measured as a percentage determined by dividing the number of covered individuals who submitted one or more claims by the total number of covered individuals.

utilization management,

n a set of techniques used by or on behalf of purchasers of health care benefits to manage the cost of health care before its provision by influencing patient-care decision making through case-by-case assessments of the appropriateness of care based on accepted dental practices.

utilization review (UR),

n 1. analysis of the necessity, appropriateness, and efficiency of medical and dental services, procedures, facilities, and practitioners. In a hospital, this includes review of the appropriateness of admissions, services ordered and provided, and length of stay and discharge practices, on concurrent and retrospective bases.
2. a statistically based system that examines the distribution of treatment procedures based on claims information and, to be reasonably reliable, the application of such claims. Analyses of specific dental professionals should include data on type of practice, dental professionals' experience, socioeconomic characteristics, and geographic location.

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utilization review

Utilization control, utilization management Managed care Evaluation of the necessity–eg, for surgery or other therapy, appropriateness–of admissions or of services ordered, and efficiency of the use of health care services, procedures, and facilities. See Utilization.