Section 325.21201. Definitions.

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Rule 1201. As used in this part:

(a)   "Medical audit" means the retrospective examination, review,   and evaluation of the clinical application of medical knowledge utilized in the diagnosis and treatment of patients as revealed in the patient's clinical record and carried out for purposes of education, accountability, and quality control.

(b)     "Quality control" means the planned and systematic medical management actions which assure the consistent acceptable quality of health care and services rendered to patients including the use of various monitoring techniques.

(c)      "Utilization   review" means retrospective, concurrent, and prospective review of the provision and utilization of health care services by providers and recipients in terms of cost, effectiveness, efficiency, and quality.

History: 1981 AACS.

                    
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