Utilization Review and Appropriateness of Services (Revised 12-12-19)

UR 1.0 - Utilization Review and Appropriateness of Services

Standard: The entity should have in place a system to ensure appropriate utilization of services offered.

Elements of Compliance:

• UR 1.1 The entity provides patient education materials related to imaging appropriateness, such as Image Gently materials.

• UR 1.2 The entity will verify whether the patient had prior imaging studies of the same anatomic area and consult with the referring provider regarding the most appropriate course of action.

• UR 1.3 The entity should provide consultative services to ordering/referring providers to assist in determination of the most appropriate exam(s) as necessary or appropriate. There should be a process to ensure exam indications, advantages-benefits and limitation-risks are readily available to the referring provider. Information on radiation exposure/risk is essential.

• UR 1.4 The entity should have a written policy and procedure for verifying that orders contain enough standardized information about modality, body region, contrast, clinical indication, medications, etc.

• UR 1.5 The entity has policies for use of specific protocols aimed at reducing unwarranted, inappropriate procedures (e.g. routine use of combined without and with contrast studies).

Revision History for this Article

Date

Section

Description of Revision(s)

12-12-19

All

Article created; FAQs incorporated; No criteria changes