Which of the following is NOT an example of utilization review?

Utilization review involves the evaluation of the necessity, appropriateness, and efficiency of the healthcare services provided to patients. It serves the purpose of ensuring that patients receive the right level of care while managing costs for the health insurance provider.

The first option, pre-authorization for hospital admissions, is a classic example of utilization review, as it requires healthcare providers to justify the necessity of an admission before it occurs. This helps to prevent unnecessary hospital stays.

The second option, evaluation of treatment effectiveness, also falls under utilization review. This process involves assessing whether a particular treatment is achieving its intended outcome, ensuring that patients receive effective care that is based on clinical evidence.

The fourth option, assessment of service necessity, directly relates to utilization review, as it evaluates whether a particular service is necessary for the patient’s health condition and aligns with established medical guidelines.

The correct answer outlines that ongoing inspection of accident-prone individuals is not considered a standard practice within utilization review. While it may involve monitoring individuals for potential health issues, it does not pertain to reviewing the necessity or appropriateness of specific medical services or treatments, which is the primary focus of utilization review processes.