An elderly female client was receiving home care after hospitalization for a cerebrovascular acci-dent. After several weeks of physical and speech therapy, the client showed few signs of pro-gress
The utilization review committee considered the client's condition to be stable and declined re-imbursement for further home care. Which of the following describes the process that could be used by the client to reverse the decision?
a. Prospective utilization review
b. Retrospective utilization review
c. Concurrent utilization review
d. Medicare reversal process
ANS: C
A concurrent utilization review is the review of the necessity of services while care is being giv-en. Doing an assessment of the necessity of care before giving service is called a prospective uti-lization review. A retrospective utilization review is an analysis of the necessity of the services received by the client after the care has been given. This is not an example of the Medicare re-versal process.
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