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Book

Utilization Management

Angelo P. Giardino  1 , Roopma Wadhwa  2
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
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Free Books & Documents
Book

Utilization Management

Angelo P. Giardino et al.
Free Books & Documents

Excerpt

Utilization Management (UM), initially referred to as Utilization Review (UR), remains a well-recognized component of a cost management approach in the health care service delivery and payment arenas. UM processes include interventions that take place before, during, and after the clinical encounter. The type of UM that occurs before the clinical event is called prior authorization or "pre-auth." If UM occurs during clinical care for a patient admitted to a facility, then this type of UM is called a concurrent review. Finally, UM that is done after the clinical encounter has occurred is called the retrospective review or "retro-review."

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Conflict of interest statement

Disclosure: Angelo Giardino declares no relevant financial relationships with ineligible companies.

Disclosure: Roopma Wadhwa declares no relevant financial relationships with ineligible companies.

References

    1. Roifman I, Austin PC, Qiu F, Wijeysundera HC. Impact of the Publication of Appropriate Use Criteria on Utilization Rates of Myocardial Perfusion Imaging Studies in Ontario, Canada: A Population-Based Study. J Am Heart Assoc. 2017 Jun 05;6(6) - PMC - PubMed
    1. Sheehy TJ, Thygeson NM. Physician organization care management capabilities associated with effective inpatient utilization management: a fuzzy set qualitative comparative analysis. BMC Health Serv Res. 2014 Dec 03;14:582. - PMC - PubMed
    1. Hendel RC. Utilization management of cardiovascular imaging pre-certification and appropriateness. JACC Cardiovasc Imaging. 2008 Mar;1(2):241-8. - PubMed
    1. Ferguson EJ, Brown M. Concurrent Case Review and Retrospective Review Using the Matrix Method Are Complementary Methods for Tracking and Improving Timeliness of Care in a Level I Trauma Center. Am Surg. 2016 Apr;82(4):319-24. - PubMed
    1. Sarkar MK, Botz CM, Laposata M. An assessment of overutilization and underutilization of laboratory tests by expert physicians in the evaluation of patients for bleeding and thrombotic disorders in clinical context and in real time. Diagnosis (Berl) 2017 Mar 01;4(1):21-26. - PubMed

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