What does a utilization review provide data about?

A utilization review primarily focuses on evaluating the necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. By analyzing data related to how frequently certain services are billed, it helps determine trends in the usage of healthcare resources and can reveal patterns of overutilization or underutilization of services.

This review process is crucial for ensuring that patients receive the appropriate level of care while also helping to manage costs and prevent unnecessary procedures. The data generated from utilization reviews contributes to better decision-making within healthcare organizations by highlighting the services that are overused or underused, thus facilitating improvements in patient care and operational efficiency.

In contrast to the incorrect options, patient demographics focus on information about the patients themselves, such as age and gender, rather than the services billed. Employee performance metrics are related to the evaluation of staff productivity and effectiveness, which is not the primary purpose of utilization review. Insurance coverage limits have to do with what an insurance policy will cover for a customer, rather than the frequency of billed services.