The patient was admitted to the hospital in congestive heart failure with the approval of the patient's insurer. After 3 days, utilization review, in conjunction with the patient's insurer, informed the physician that there was insufficient documentation in the patient's record to justify further hospitalization and that no additional charges would be reimbursed. Utilization review's action in this case is called:

Question

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The action taken by utilization review to inform the physician that there was insufficient documentation to justify further hospitalization and to deny additional charges for continued stay is known as continued stay denial. This is a common practice in managed care organizations, where there is a focus on cost containment while ensuring appropriate and effective medical care. Admission denial would have been the case if the patient was not allowed to be admitted in the first place, and discharge planning refers to the process of planning for a safe and appropriate discharge from the hospital.

The Patient Was Admitted to the Hospital in Congestive Heart