Concurrent Utilization

For this module we discuss the outcomes of a concurrent utilization review. I will

then identify the three strengths of a concurrent utilization review and two weaknesses

associated with this process. At the conclusion of this paper, I will identify the most

significant and beneficial finding from this study concerning utilization review.

Concurrent utilization reviews are used for approval of medically necessary

treatments or services. However, concurrent reviews happen during active management

of a condition, either inpatient or an ongoing outpatient care. The focus of the concurrent

review is to ensure that the patient is getting the right care in a timely and cost-effective

way. An important part of the concurrent review is the assessment of the patient's needs

after hospitalization. Because concurrent review is used to decrease the amount of time

you spend in a hospital, which leads us to our first strength of concurrent utilization.

The first concurrent review often determines a discharge plan. This plan can include

transfers to rehabilitation, hospice or nursing facilities. While these discharge plans often

change due to complications or abnormal test results, establishing an early time frame for

hospitalization is key to keeping health insurance costs down. This can lead us to