How does utilization management within the hospital setting ...

[Engineer]

How does utilization management within the hospital setting differ from utilization management in the ambulatory care setting?

Question 2

The main factor usually considered in choosing a coding system for ambulatory care is ___________________ _________________.
 a. what is easiest for the physicians
  b. what is required by third-party payers
  c. what is easiest for the coders
  d. what is required by the state health department

[sultansheikh]

Answer to Question 1

In the hospital setting, utilization management focuses on whether the patient requires hospitalization. In the ambulatory care setting, utilization management focuses on the necessity of a service such as referral to a specialist or the use of an expensive procedure.

Answer to Question 2

b. what is required by third-party payers

[Engineer]

Great answer, keep it coming

[jackie]

Thanks for the timely response, appreciate it