An episode of care includes all the services provided to a patient to treat a clinical condition or procedure. Attention episodes are sets of encounters or revenues with a common purpose. Often, it's a patient's condition that encompasses several encounters, such as pregnancy, back pain, or workers' compensation. Encounters can be linked to a health care episode to facilitate review and reporting.
The materials on this page are designed to provide you with an introduction to the Episodes of Care program. An episode focuses on the medical care provided in connection with an acute medical care episode and is triggered by specific claims submitted by a facility, a group of providers, or an individual provider. The duration of the episode, or interval of episodes, can include the time before the trigger (before the trigger), during the triggering period, and after the trigger (after the trigger). The episode may include services from several providers, but the episode is designed to include only the expenses corresponding to episode.
An episode grouper is software that operates algorithms that determine when an episode should be opened and closed; identifies the health services that should be assigned to one or more different health care episodes; and determines what other episodes a particular episode can be associated with. In that sense, an episode will include all clinical-related services provided for a specific condition or in conjunction with the performance of a procedure and the prices paid for them. The 20 main new causes of the encounter and the new episodes of attention, as well as the relationship between the reason for the encounter (headache) and the disease (sinusitis), support the potential of episodic epidemiology and some important clinical considerations in family medicine. Services are considered to be relevant to an episode if they can be used in the care provided during that episode and are provided during the period in which that episode occurs, regardless of whether such services are considered clinically appropriate or not.
