Utilization Review - Legislation & jurisprudence
Research News and Information

Sunday, November 22, 2009

[Drug utilization and pharmaceutical cost-containment in germany-perspectives 1 year after enactment of the GMG]

13 Jun 2005 After 3 decades of health care cost containment in Germany, enactment of the most recent reform (Health Insurance Modernization Act, GMG) marks a watershed insofar as, apparently, the potential has been largely exhausted for further savings in ... Read more...

[Effects of minimum volume regulations on the provision of health care services in cardiology]

30 Jan 2005 In order to improve the quality of medical care, minimum volumes for services were set. Hospitals are only permitted to continue to provide these services and settle accounts with the health insurance companies if they are able to achieve these ... Read more...

Utilization review and managed health care liability.

28 Feb 2004 This article explores the development of jurisprudence interpreting application of the Employee Retirement Income Security Act of 1974 to patient care denials by managed care. It identifies quality-of-care protections for patient care under present ... Read more...

Latest indexed articles for 'Utilization Review - Legislation & jurisprudence'

These are the very latest articles for this heading:

• Changes in the number of people with intellectual and developmental disabilities living in u.s. Nursing facilities between 1988 and 2007. 30 May 2009
• Important lessons learned. 28 Feb 2008
• Caught in the middle. Racketeering lawsuit centers on role of hospitalists. 18 Aug 2007
• [Drug utilization and pharmaceutical cost-containment in germany-perspectives 1 year after enactment of the GMG] 13 Jun 2005
• [Effects of minimum volume regulations on the provision of health care services in cardiology] 30 Jan 2005
• Utilization review and managed health care liability. 28 Feb 2004
• [Health situation of and health service provided for adult migrants--a survey conducted during school admittance examinations] 30 Jan 2004
• Finance issue brief: medical necessity: year end report-2003. 29 Dec 2003
• Utilisation review liability. 30 May 2003
• Nurse-evaluator uncovers Medicaid fraud scheme. Case on point: Goubran v. Dir. State Dept. of Health Srvcs., 2002 WL 31256887 P.2d -CA. 29 Sep 2002
• [Quality of Statutory Inpatient Database Before Introducing DRGs] 29 Sep 2002
• Here's what's behind that thing you do. 29 Sep 2002
• When an HMO denial is practicing medicine. 5 Jun 2002
• Regulatory oversight of case management services and other medical management functions. 30 Dec 2001
• The liability of medical directors for utilization review decisions. 30 Dec 2001
• Surgical and specialty hospitals: a legal primer. 30 Dec 2001
• HIPAA privacy and security regulations. 27 Feb 2001
• Reviewing the reviewers. 30 Jan 2001
• American Manufacturers Mutual Insurance Company v. Sullivan: "Meta-Analysis" as a tool to navigate through the Supreme Court's "state action" maze. 30 Dec 2000
• Will external review mandates revolutionize managed care? 29 Sep 2000

See a longer list of these articles.

Technical information about 'Utilization Review'

Definition: An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.

Descriptor UI: D014600

Alternative terms: Utilization Review; Review, Utilization; Reviews, Utilization; Utilization Reviews;

Related Mesh Headings: Insurance Claim Review;

Allowable Qualifiers: standards; trends; utilization; statistics & numerical data; ethics; methods; classification; economics; history; legislation & jurisprudence; organization & administration;

Tree Number: N04.761.879; N05.700.900;

History Note: 68

Technical Notes: DF: UTIL REV