What is a Utilization Review and Why You Need One

A utilization review (UR) is a structured audit of your charts, billing, and care delivery to confirm that what you billed matches what you provided and what was authorized.

What gets reviewed Authorizations, assessments, care plans, visit notes, EVV records, supervisory visits, caregiver credentials, and claim submissions.

What you get A written report with findings, corrective actions, and prioritized fixes. Done quarterly, UR prevents most large recoupments.

Who needs it Any agency billing Medicaid, VA, or commercial insurance. Private-pay-only agencies still benefit because UR also surfaces unbilled hours.

We perform external UR audits with same-week turnaround.