Explain the term "utilization review."

Utilization review is a critical process in health care finance that focuses on evaluating the necessity, appropriateness, and efficiency of health care services provided to patients. This review system is typically conducted by insurance companies or health care organizations to ensure that the services being performed are warranted based on established guidelines and standards.

The goal of utilization review is to ensure that patients receive appropriate care while also managing costs for healthcare providers and payers. By assessing whether specific treatments, procedures, or hospital stays are necessary and beneficial based on clinical guidelines, the process helps prevent overutilization of services, which can lead to unnecessary costs and potential harm to patients.

It involves a thorough analysis of the patient's clinical situation, including diagnoses, medical history, and the proposed treatment plan. This evaluation helps maintain the quality of care and supports cost-effectiveness in the health care system.

Other options such as determining pricing, assessing demographic data, or conducting financial audits focus on different aspects of health care management and finance but do not encapsulate the purpose and function of utilization review in the same comprehensive way.