What does utilization review often require according to the medical record data?

Utilization review is a process used by healthcare organizations to evaluate the necessity and efficiency of the care being provided to patients. This often involves assessing the medical record data to determine whether the services being rendered are appropriate and medically necessary.

The requirement for justification for additional procedures or hospital days stems from the need to ensure that all aspects of patient care are warranted and align with established clinical guidelines. When a patient’s treatment plan includes additional procedures or extended hospital stays, it is crucial for healthcare providers to substantiate these actions with documented medical reasons. This not only helps maintain high-quality care but also plays a significant role in controlling healthcare costs and ensuring that resources are used effectively.

The other options do not typically fall under the core function of utilization review. Verification of a patient's identity is a standard administrative process to ensure accurate records but does not relate directly to the necessity of care being reviewed. Scheduling follow-up appointments is more related to patient management rather than the evaluation of care services provided. Similarly, conducting health assessments can be part of general patient care but is not a specific requirement of utilization review, which focuses on evaluating the necessity of ongoing or additional treatments.