Which term describes the process that controls healthcare costs by reviewing the necessity of care?

Utilization Management is the term that accurately describes the process of controlling healthcare costs by reviewing the necessity of care. This process involves a systematic evaluation of the appropriateness and necessity of healthcare services, procedures, and treatments before they are delivered. The main goal of Utilization Management is to ensure that patients receive the necessary level of care while avoiding unnecessary services that can lead to increased costs.

This practice is essential because it helps healthcare organizations manage resources effectively, improve patient outcomes, and maintain a focus on evidence-based guidelines. It often involves tools such as prior authorization, concurrent review, and retrospective review, which all serve to assess whether the care being requested aligns with established medical guidelines and is warranted based on the patient's condition.

Other options do not align accurately with the definition in question. Claims Review focuses on verifying the details of submitted claims for payment, Care Coordination centers on organizing patient care across different providers, and Financial Oversight pertains to the management of financial resources and budgeting, rather than the clinical necessity of care itself.