Which term corresponds to activities ensuring appropriate use of healthcare services?

Which term corresponds to activities ensuring appropriate use of healthcare services?

• A. Prospective Utilization Review
• B. Utilization Management (UM)
• C. Concurrent Utilization Review
• D. Retrospective Utilization Review

Answer: (B)

Utilization Management is the broad program that ensures appropriate use of healthcare services by coordinating activities across the care continuum. It includes prospective utilization review, which evaluates medical necessity before services, concurrent utilization review, which monitors care while it’s happening to keep it appropriate and efficient, and retrospective utilization review, which looks back after care to assess whether the services were appropriate and to guide future practice. Because the question asks for the term that covers ensuring appropriate use overall, the umbrella concept of Utilization Management is the best fit. The other terms describe specific review activities at different times rather than the overarching management function.

Utilization Management is the broad program that ensures appropriate use of healthcare services by coordinating activities across the care continuum. It includes prospective utilization review, which evaluates medical necessity before services, concurrent utilization review, which monitors care while it’s happening to keep it appropriate and efficient, and retrospective utilization review, which looks back after care to assess whether the services were appropriate and to guide future practice. Because the question asks for the term that covers ensuring appropriate use overall, the umbrella concept of Utilization Management is the best fit. The other terms describe specific review activities at different times rather than the overarching management function.