Distinguish between the two basic approaches to utilization management: prospective review/precertification and retrospective review
In prospective review/precertification the service is examined before it is provided. Data are collected from the patient and the physician to compare the data to appropriate criteria. If the standards are met, the service can be provided. If the standards are not met, a physician advisor may be asked to review the case and make a determination. In retrospective review, care is looked at after it is given. Data are collected from a sample of medical records, and the information from the record is compared to the appropriate standards. Feedback then is given to the caregiver regarding inappropriate care provided.
You might also like to view...
When ________ happens, the overgrowth of the tissue prevents the stapes from transmitting sound vibrations to the inner ear. The result is profound hearing loss involving one or both ears
a. otitis media b. otosclerosis c. Ménière's disease d. presbycusis
The ____ is the federal official responsible for incident management.
A. Secretary of Defense B. Secretary of Homeland Security C. President D. Attorney General
Which agents may bring on a disease condition that will exhibit signs in the oral cavity?
a. Physical b. Chemical c. Biological d. All of the above
At what gestational age does the terminal sac period begin?
a. 26 weeks c. 24 weeks b. 20 weeks d. 22 weeks