Which utilization review occurs during care and includes discharge planning?

Which utilization review occurs during care and includes discharge planning?

• A. Before care; includes prior authorization
• B. During care; price review
• C. During care; includes discharge planning
• D. After care; evaluates necessity and appropriateness

Answer: (C)

Concurrent review is the utilization review that happens during the course of treatment and often includes discharge planning to arrange post-discharge needs. This approach monitors ongoing care to ensure services remain appropriate while planning for a safe transition out of the acute setting, coordinating with post-acute care, home health, medications, and follow-up. Prospective review occurs before care and focuses on pre-authorization. Retrospective review happens after care to evaluate whether services were necessary and appropriate. Price review is not the standard focus of utilization management.

Concurrent review is the utilization review that happens during the course of treatment and often includes discharge planning to arrange post-discharge needs. This approach monitors ongoing care to ensure services remain appropriate while planning for a safe transition out of the acute setting, coordinating with post-acute care, home health, medications, and follow-up.

Prospective review occurs before care and focuses on pre-authorization. Retrospective review happens after care to evaluate whether services were necessary and appropriate. Price review is not the standard focus of utilization management.