Which of the following involves analyzing a case before admission to determine what type of treatment is necessary?

Prospective Review is the process of assessing a patient's case before they are admitted to a healthcare facility, focusing on determining the necessary type of treatment or services required based on medical necessity and appropriateness. This review is conducted prior to the patient's actual admission, allowing healthcare providers to ensure that the recommended treatments align with established guidelines and protocols.

By analyzing the details of the case beforehand, insurance companies and healthcare administrators can make informed decisions about coverage and resource allocation, ultimately leading to more effective patient care and managing costs effectively. This proactive approach benefits both the patient and the healthcare system as it helps to prevent unnecessary admissions and ensures that patients receive the appropriate level of care right from the start.

In contrast, other types of reviews, such as Retrospective Review, focus on cases after treatment has occurred to determine if the services provided were appropriate and necessary. Concurrent Review takes place during the patient’s treatment to evaluate the ongoing necessity of care. There is also no standard term known as Assessment Review in this context. Understanding these distinctions is key in navigating the medical review process within health insurance frameworks.