1. Form of health care review in which a component of the quality assurance program audits and monitors the quality of both the delivery and organization of medical services. The purpose is to ensure that health care services are appropriate to the patients’ needs and of the highest quality and that the managed care plan in place supports and provides the care. 2. The Medicare Conditions of Participation require an audit with the use of screening criteria for evaluation by diagnosis and/or procedure. Utilization review requirements under Medicare and Medicaid require utilization review committees in hospitals and skilled nursing facilities to have at least one such study in progress at all times. Such studies are required by the Quality Improvement Organization (QIO) program. This is called medical care evaluation studies (MCE studies) .