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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Retrospective drug utilization review refers to drug therapy review that after patients have got the medication. [10] The retrospective drug utilization review has a typical process. [12] This is a computer based review. Computer will show data which are in violation of the standard.
An example to highlight clinical coding experience would be the standard within the Australian Coding Standards 0010 General Abstraction Guidelines. [9] These guidelines indicate that a coder must seek further detail within a record in order to correctly assign the correct diagnoses code.
The CPT code revisions in 2013 were part of a periodic five-year review of codes. Some psychotherapy codes changed numbers, for example 90806 changed to 90834 for individual psychotherapy of a similar duration. Add-on codes were created for the complexity of communication about procedures.
Dual diagnosis (also called co-occurring disorders (COD) or dual pathology) [1] [2] is the condition of having a mental illness and a comorbid substance use disorder.There is considerable debate surrounding the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems.
Coding conventions are only applicable to the human maintainers and peer reviewers of a software project. Conventions may be formalized in a documented set of rules that an entire team or company follows, [1] or may be as informal as the habitual coding practices of an individual. Coding conventions are not enforced by compilers.
The most commonly used guidelines are published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). [36] There are 11 diagnostic criteria which can be broadly categorized into issues arising from substance use related to loss of control, strain to one's interpersonal life, hazardous use, and pharmacologic effects.
A retrospective cohort study, also called a historic cohort study, is a longitudinal cohort study used in medical and psychological research. A cohort of individuals that share a common exposure factor is compared with another group of equivalent individuals not exposed to that factor, to determine the factor's influence on the incidence of a ...