Which process will the insurer oversee the insured's hospital stay to confirm that care is proceeding as planned and that discharge occurs as scheduled?

Which process will the insurer oversee the insured's hospital stay to confirm that care is proceeding as planned and that discharge occurs as scheduled?

• A. Concurrent review
• B. Utilization review
• C. Prospective review
• D. Retrospective review

Answer: (A)

Monitoring inpatient care in real time to ensure that treatment stays on track and discharge happens as planned is the process described here. This is concurrent review, where the insurer reviews the patient's care while they are still in the hospital to verify that the level of care, course of treatment, and discharge timing are appropriate. Prospective review happens before services or admission to authorize them, and retrospective review occurs after care to evaluate whether the services were appropriate. Utilization review is the broader umbrella term that includes prospective, concurrent, and retrospective activities. But since the focus is on supervising the hospital stay as it unfolds and ensuring discharge occurs as scheduled, concurrent review is the best fit.

Monitoring inpatient care in real time to ensure that treatment stays on track and discharge happens as planned is the process described here. This is concurrent review, where the insurer reviews the patient's care while they are still in the hospital to verify that the level of care, course of treatment, and discharge timing are appropriate.

Prospective review happens before services or admission to authorize them, and retrospective review occurs after care to evaluate whether the services were appropriate. Utilization review is the broader umbrella term that includes prospective, concurrent, and retrospective activities. But since the focus is on supervising the hospital stay as it unfolds and ensuring discharge occurs as scheduled, concurrent review is the best fit.