{"product_id":"utilization-review-u-s-government-accountability-office-9781289069841","title":"Utilization Review: Information on External Review Organizations: HRD-93-22FS","description":"Pursuant to a congressional request, GAO reviewed utilization review organizations (URO), focusing on: (1) the size and ownership of URO; (2) the professional qualifications of staff involved in utilization review decisions; (3) the complexity of decisions made by various staff; (4) appeal procedures; (5) clinical review criteria used by URO; and (6) quality assurance procedures implemented to ensure adherence to company directives. \u003cbr\u003e \u003cbr\u003e GAO found that: (1) physicians are usually employed by URO on a part-time basis or as consultants\/advisors; (2) registered nurses are heavily involved in first-level review decisions, but physicians become more involved during the second-level review and appeal process; (3) URO generally used commercially developed review criteria when making recommendations; (4) most URO have established appeal procedures; (5) of the few utilization decisions that are appealed, many are successful; (6) URO have implemented quality assurance procedures to ensure adherence to company directives; (7) in 1990, a commission was established to develop quality assurance standards for URO and to accredit organizations that seek this distinction; (8) many URO set minimum qualifications and education levels for clinical and nonclinical staff; and (9) URO activities included prehospital admission certification review, concurrent reviews, second surgical opinions, and case management.\u003cbr\u003e\u003cbr\u003e\u003cb\u003eAuthor:\u003c\/b\u003e U. S. Government Accountability Office (\u003cbr\u003e\u003cb\u003eISBN-10:\u003c\/b\u003e 1289069840\u003cbr\u003e\u003cb\u003eISBN-13:\u003c\/b\u003e 9781289069841\u003cbr\u003e\u003cb\u003ePublisher:\u003c\/b\u003e Bibliogov\u003cbr\u003e\u003cb\u003eLanguage:\u003c\/b\u003e English\u003cbr\u003e\u003cb\u003ePublished:\u003c\/b\u003e 06\/27\/2013\u003cbr\u003e\u003cb\u003ePages:\u003c\/b\u003e 104\u003cbr\u003e\u003cb\u003eFormat:\u003c\/b\u003e Paperback\u003cbr\u003e\u003cb\u003eWeight:\u003c\/b\u003e 0.44lbs\u003cbr\u003e\u003cb\u003eSize:\u003c\/b\u003e 9.69h x 7.44w x 0.22d","brand":"U. S. Government Accountability Office (","offers":[{"title":"Paperback","offer_id":48873004368127,"sku":"9781289069841","price":18.75,"currency_code":"USD","in_stock":true}],"url":"https:\/\/www.whiterainbookhouse.com\/products\/utilization-review-u-s-government-accountability-office-9781289069841","provider":"WR Book House","version":"1.0","type":"link"}