Tips to help take the hassle out of inpatient utilization review.

For the last 10 years, I’ve been on both sides of utilization review (UR). As a practicing physician, I know what it’s like to get “those calls.” As a part-time utilization reviewer, I’m usually satisfied with the interactions I have with physicians and the information I get from them. When a telephone review seems unsatisfactory, it’s often because I feel I’m speaking a different language than the treating doctor. Perhaps I am. I’ve been trained in how to review cases, but doctors receive no training in how to be the recipients of “those calls.” I hope this article helps to fill that educational gap by helping you better understand the process of inpatient review and how you can help make it less painful. I’ll explore what inpatient review means, present some typical cases and suggest how you can help minimize your aggravation with the process. The goal is to reduce the number of calls you have to return and the time you have to spend defending your work.