A Focus on Regulations: Analyzing Trends in Utilization Management

Share this post:

This session  examined the evolution of utilization management (UM) programs and related medical management functions over the past three decades with a detailed overview of how UM programs are regulated. Among other issues, speakers  highlighted the impact of the Affordable Care Act and other regulatory reforms on the ways that health plans make “medical necessity” determinations and how the appeals process works when a “denial” of care or adverse benefit determination is made. In addition, the presentation  reviewed the scope, licensure requirements, reviewer qualifications and the ways in which UM services are often integrated into a “care coordination” approach to managing patients. The session also  examined liability issues associated with the “corporate practice of medicine.”

View This Webinar

Scroll to Top