Monitoring a patient's prognosis for recovery becomes important in which type of utilization review?
Concurrent
Preauthorization
Retrospective
Prospective
The Correct Answer is A
A. Concurrent: Concurrent utilization review involves the ongoing monitoring of a patient's care and recovery while they are still receiving treatment. This type of review focuses on ensuring that the care provided is appropriate and that the patient is progressing as expected.
B. Preauthorization: Preauthorization involves obtaining approval from a health insurer before a service is provided to ensure it will be covered. It does not focus on monitoring a patient's recovery.
C. Retrospective: Retrospective review involves evaluating the care provided to a patient after the treatment has been completed. It looks at the appropriateness of care but does not monitor ongoing recovery.
D. Prospective: Prospective review involves evaluating the necessity of a treatment before it begins. It does not include ongoing monitoring of a patient's prognosis for recovery.
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Related Questions
Correct Answer is D
Explanation
Rationale:
A. Place caps on the rise of health insurance premiums: This option does not align with the main purpose of the Health Maintenance Organization (HMO) Act of 1973, which aimed to promote
the development of HMOs as an alternative to traditional fee-for-service models rather than directly addressing insurance premiums.
B. Transfer the control of HMOs from the federal government to private companies: The HMO Act of 1973 aimed to encourage the establishment of HMOs by providing federal grants and
loans, but it did not involve transferring control from the government to private companies.
C. Rein in the growing power of managed care: The HMO Act of 1973 actually facilitated the growth of managed care by providing federal support for the establishment of HMOs, rather than attempting to rein in their power.
D. Provide an alternative to fee-for-service: The primary purpose of the HMO Act of 1973 was to promote and facilitate the development of Health Maintenance Organizations (HMOs) as an
alternative healthcare delivery model to traditional fee-for-service arrangements. HMOs were intended to emphasize preventive care, cost containment, and coordination of services.
Correct Answer is B
Explanation
Rationale:
A. Health insurance companies: While health insurance companies play a significant role in healthcare financing and administration, they are not typically drivers of future change in healthcare service delivery.
B. Technological innovation: Technological advancements, such as telemedicine, artificial
intelligence, wearable devices, and precision medicine, are major forces shaping the future of healthcare service delivery by improving access, efficiency, and patient outcomes.
C. Lawyers: While legal factors may influence aspects of healthcare delivery, they are not typically considered primary forces for future change in service delivery.
D. Doctors and Nurses: While healthcare professionals are integral to the delivery of care, they are not drivers of systemic changes in healthcare service delivery.
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