What is the term for the process of determining the medical necessity of a patient's care?

Utilization review is the process specifically focused on assessing the medical necessity of a patient's care. It involves evaluating the appropriateness and efficiency of health care services, procedures, and facilities. The goal of this process is to ensure that patients receive care that is appropriate for their medical conditions while also managing costs and resources effectively.

Utilization review typically involves healthcare professionals reviewing patient records, treatment plans, and specific criteria based on established guidelines to determine if the services provided meet the necessary standards for medical necessity. This process can help prevent unnecessary procedures and ensure that patients receive the right level of care for their needs.

Quality control relates more to the overall standards of care and does not specifically address the medical necessity aspect. Case management involves coordinating a patient's overall care, which may include considerations of medical necessity but is broader in scope. Patient advocacy focuses on supporting patients to ensure they receive appropriate care and navigate the healthcare system effectively, but it does not specifically evaluate the necessity of care from a clinical perspective.