Use of Medical Necessity Scales in Concurrent Review of Psychiatric Inpatient Care

The authors describe, by use of a case example, how medical necessity scales work & contribute to better communication in the utilization review process. The case is that of a 30-year-old woman who was admitted for inpatient care by her outpatient psychiatrist, who felt that she had become a serious suicidal risk. Results of the utilization review led to the conclusion that the patient was not imminently suicidal or aggressive & could be treated in a less restrictive environment. (4 refs.)