reimbursement: utilization review
Also known as utilization management or utilization control, utilization review is a systematic means for reviewing and controlling patients' use of medical care services as well as the appropriateness and quality of that care. Usually involves data collection, review and/or authorization, especially for services such as specialist referrals, emergency room use, and hospitalization.*
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*Extracted from Family Physicians and Managed Care: A View to the 90's: (paperback 1993) with permission from American Academy of Family Physicians