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UM is the evaluation of the appropriateness and medical necessity of health care services, procedures, and facilities according to evidence-based criteria or guidelines, and under the provisions of an applicable health insurance plan. Typically, UM addresses new clinical activities or inpatient admissions based on the analysis of a case.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines. UM criteria are medical guidelines which may be developed in house ...
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Milliman, formerly Milliman & Robertson, is an international actuarial and consulting firm based in Seattle, Washington. The company was founded in 1947, by Wendell Milliman and Stuart A. Robertson and operates 59 offices internationally, with over 3,000 employees.
An admission note is part of a medical record that documents the patient's status (including history and physical examination findings), reasons why the patient is being admitted for inpatient care to a hospital or other facility, and the initial instructions for that patient's care.
Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma .
These are generally applied through administrative data analysis, but referrals for peer review are frequently made by risk managers, nurses and medical staff. The median annual review volume is 1–2% of hospital inpatient admissions. Thus, case review may be the dominant form of adverse event analysis in US hospitals.
Medical observation is a medical service aimed at continued care of selected patients, usually for a period of 6 to 24 (sometimes more) hours, to determine their need for inpatient admission. This service is usually provided in emergency departments.