Author Question: How does utilization management within the hospital setting differ from utilization management in ... (Read 55 times)

Engineer · **on:** Jul 12, 2018

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 · **Reply #1 on:** Jul 12, 2018

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