Which utilization review phase monitors ongoing care to ensure it remains appropriate?

Which utilization review phase monitors ongoing care to ensure it remains appropriate?

• A. Audit
• B. Prospective
• C. Concurrent
• D. Retrospective

Answer: (C)

When care is being delivered and adjustments may be needed based on what’s happening with the patient, that’s concurrent utilization review. It involves real-time assessment of the ongoing plan to confirm continued medical necessity, appropriateness of interventions, and length of stay, with the option to modify or discontinue services if appropriate. Prospective review happens before care begins to decide what will be done. Retrospective review looks back after care is completed to evaluate whether the services were appropriate. An audit is a broad quality-control activity that may examine records or processes, but the phase focused on during-treatment monitoring is the concurrent one.

When care is being delivered and adjustments may be needed based on what’s happening with the patient, that’s concurrent utilization review. It involves real-time assessment of the ongoing plan to confirm continued medical necessity, appropriateness of interventions, and length of stay, with the option to modify or discontinue services if appropriate.

Prospective review happens before care begins to decide what will be done. Retrospective review looks back after care is completed to evaluate whether the services were appropriate. An audit is a broad quality-control activity that may examine records or processes, but the phase focused on during-treatment monitoring is the concurrent one.