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Exam (elaborations)

UTILIZATION MANAGEMENT NURSE EXAM

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UTILIZATION MANAGEMENT NURSE EXAM 1.Utilization - CORRECT ANSWERS-How efficient a facility is in providing necessary care in the most cost-effective manner Goal of Utilization Review - CORRECT ANSWERS-1. To prevent overutilization or underutilization of resources 2. To control inappropria...

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  • January 25, 2024
  • 8
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers
  • UTILIZATION MANAGEMENT NURSE
  • UTILIZATION MANAGEMENT NURSE
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jackwa
UTILIZATION MANAGEMENT
NURSE EXAM 2023\2024

, 1.Utilization - CORRECT ANSWERS-How efficient a facility is in providing
necessary care in the most cost-effective manner

Goal of Utilization Review - CORRECT ANSWERS-1. To prevent overutilization
or underutilization of resources



2. To control inappropriate use of health resources

Overutilization - CORRECT ANSWERS-1. Using to many unnecessary
resources

2. Not needed for that diagnosis or treatment

Example; using the ER for runny nose

Underutilization - CORRECT ANSWERS-1. Hospital resources not used when
they were necessary



Example: Discharge a patient too soon or not giving patient adequate tests
or readmission to hospital

Medical Necessity - CORRECT ANSWERS-Is or Was the treatment medically
necessary and appropriate for that patient

- Tests

- Surgical Procedures

- Ancillary Services

Utilization Review - CORRECT ANSWERS-1. UR evaluates the level of care
needed

2. First became mandatory in 1965 with Medicare.

3. First Attempt at UR - PSRO - Failed

- 1972 Professional Standards Review Organization (PSRO) Had no Teeth
authority) and could not enforce standards they could only suggest things

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