{ "item_title" : "Utilization Review", "item_author" : [" U. S. Government Accountability Office ( "], "item_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. 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.", "item_img_path" : "https://covers2.booksamillion.com/covers/bam/1/28/906/984/1289069840_b.jpg", "price_data" : { "retail_price" : "18.75", "online_price" : "18.75", "our_price" : "18.75", "club_price" : "18.75", "savings_pct" : "0", "savings_amt" : "0.00", "club_savings_pct" : "0", "club_savings_amt" : "0.00", "discount_pct" : "10", "store_price" : "" } }

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