Evaluation of health care services to determine medical necessity and appropriateness of medical care during the time the services are being provided. It is done to encourage discharge of the patient from the hospital as soon as his or her medical condition no longer needs continued inpatient care. This may occur for inpatient, residential, partial hospitalization treatment, and outpatient care. The review is usually done at the time services are provided by a health care provider other than the one giving the care.
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A case management technique which allows insurers to monitor an insured’s hospital stay and to know in advance if there are any changes in the expected period of confinement and the planned release date.