Which statement best describes the typical orientation of peer review in utilization review?

• A. Retrospective and concurrent review of client records; educational, not punitive; aims to improve quality of care
• B. Prospective authorization of services
• C. Financial audit to identify waste
• D. Administrative discharge planning

Answer: (A)

Peer review in utilization review is oriented toward quality improvement, with clinicians reviewing patient records during and after care to learn and improve practice rather than to punish. Retrospective review examines what happened after care to judge the appropriateness of decisions and the use of resources, while concurrent review happens during care to spot issues in real time and adjust course. The emphasis is educational and aimed at enhancing care quality and appropriate utilization.

Prospective authorization of services is about approving care before it happens, which is a pre-authorization process rather than the peer-review focus on evaluating care decisions after or during treatment. A financial audit to identify waste targets cost and efficiency, not the clinical evaluation of decisions or educational improvement. Administrative discharge planning deals with coordinating care transitions, not the peer-review process used to review clinical decisions for quality improvement.