Certified Revenue Cycle Representative (CRCR) Practice Exam

What is the purpose of utilization review in healthcare?

1. To evaluate patient satisfaction with services

2. To assess the appropriateness and quality of healthcare services

3. To promote new healthcare practices

4. To record the financial transactions of healthcare services

The correct answer is: To assess the appropriateness and quality of healthcare services

The purpose of utilization review in healthcare is to assess the appropriateness and quality of healthcare services. This process involves evaluating whether the services provided to patients are necessary and whether they meet established standards of care. Utilization review helps ensure that patients receive the right level of care at the right time, avoiding unnecessary procedures and hospitalizations, which can lead to better healthcare outcomes and optimized resource use. This role is crucial in managing healthcare costs and maintaining quality standards across various clinical settings. Healthcare providers utilize these reviews to monitor treatment plans, adherence to protocols, and the overall effectiveness of the care delivered, ensuring that patients receive high-quality, evidence-based medical attention. The other options, while related to aspects of healthcare, do not accurately describe the primary focus of utilization review. Evaluating patient satisfaction involves understanding patients' perspectives on their care, which is not the main objective of utilization review. Promoting new healthcare practices pertains more to innovation and research within the healthcare industry, while recording financial transactions relates to accounting practices, which are separate from the clinical focus of utilization review.