Utilization Management Through Medical and Pharmacy Benefit | AJMC
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Why understanding utilization review is key for physicians As physicians, it’s important to understand the role of utilization review staff in the healthcare system. While nobody likes to play the game of ensuring proper admission status, it’s a necessary part of ensuring the hospital gets paid for the care provided. If the admission status is incorrect, the hospital could receive no payment for the entire stay of the patient, even if they received great care from the physician. Utilization revi
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Health Utilization Management Accreditation - URAC
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