Certified Medical Administrative Assistants (CMAA) Practice Exam 2026 - Free CMAA Practice Questions and Study Guide

Utilization review is a systematic process that evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. This process plays a key role in monitoring healthcare quality and controlling costs by assessing whether the services align with established guidelines or evidence-based standards.

By conducting utilization reviews, healthcare organizations can identify overuse or underuse of services, ensuring that patients receive appropriate care while avoiding unnecessary expenses. Through this approach, providers can improve the cost-effectiveness of treatments, which is essential in managing overall patient care and organizational budgets.

In contrast, while quality assurance focuses on maintaining a certain standard of care and improving patient outcomes, it doesn’t specifically address cost management to the same extent as utilization review. Cost-benefit analysis typically evaluates the financial implications of specific interventions rather than ongoing monitoring of healthcare practices. Risk management primarily deals with minimizing potential liabilities and preventing harm to patients, which, while vital, does not directly address the overarching control of healthcare quality and costs in the same detailed way as utilization review does.