What is the primary role of the Utilization Review Committee (URC) in Medicare service provider hospitals?

The primary role of the Utilization Review Committee (URC) in Medicare service provider hospitals centers around overseeing admissions, costs of care, and quality specifically for Medicare beneficiaries. This responsibility is essential because it ensures that patients receive appropriate and necessary medical services while also evaluating whether the services provided align with Medicare guidelines and standards.

By focusing on admissions, the URC examines whether the reasons for hospitalizations meet medical necessity criteria. This helps to prevent unnecessary admissions and ensures that patients are allocated to the right level of care. When it comes to cost of care, the URC reviews treatment expenses to ascertain that they are justified and compliant with Medicare reimbursement policies, which is vital for the hospital’s financial health and sustainability.

Additionally, quality oversight ensures that the care provided meets accepted standards, thereby enhancing patient outcomes and safety. This systematic review helps to maintain high standards of care while also controlling healthcare costs within the Medicare program, ultimately benefiting both patients and healthcare providers.

The other options involve functions that the URC does not typically handle. Establishing new healthcare laws is a function of legislative bodies and regulatory agencies, not hospital committees. Providing marketing support for hospitals is related to the hospital’s administrative function and marketing teams, rather than the URC's role. Regulating insurance