Utilization Review: Information on External Review Organizations
HRD-93-22FS
Published: Nov 24, 1992. Publicly Released: Jan 06, 1993.
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Highlights
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.
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Health care personnelHealth care servicesHealth insuranceHealth resources utilizationHealth services administrationPhysiciansQuality assuranceNursesAppeals processUtilization review