Clinical Episode definition

Clinical Episode means the following family of related MS-DRGs for a clinical condition to be tested through an Episode of Care under Model 4: DRG ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ w/ PTCA w/ ▇▇▇* ▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ w/ PTCA w/o MCC* DRG 233 Coronary Bypass w/ Cardiac Cath w/ ▇▇▇* ▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ w/ Cardiac Cath w/o MCC* DRG 235 Coronary Bypass w/o Cardiac Cath w/ MCC* DRG 236 Coronary Bypass w/o Cardiac Cath w/o MCC* *MCC = major co-morbidities or complications
View Source
Clinical Episode means the period of time described in Article 5.2 initiated on the first day of an Anchor Stay or an Anchor Procedure, during which all Medicare FFS expenditures for all
View Source
Clinical Episode means a family of related MS-DRGs for a clinical condition to be tested through an Episode of Care under Model 4. All Clinical Episodes that will be subject to the terms and conditions of this Agreement will be identified in the Awardee Profile (Attachment C) for each Episode Initiator. The Clinical Episodes will include, without limitation, the family of related MS-DRGs for the clinical condition to be tested and a set of exclusions based on MS-DRGs and International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, which is referred to in Attachment A.
View Source

Examples of Clinical Episode in a sentence

  • If the date of completion for the Anchor Procedure occurs on or after the effective date of termination, or the Clinical Episode is a COVID-19 Clinical Episode, the Participant will not be held accountable for the Clinical Episode for purposes of Reconciliation or the Post- Episode Monitoring Spending Calculation.

  • If the date of discharge from the Anchor Stay occurs on or after the effective date of termination, or the Clinical Episode is a COVID-19 Clinical Episode, the Participant will not be held accountable for the Clinical Episode for purposes of Reconciliation or the Post-Episode Monitoring Spending Calculation.

  • The AFP for each Clinical Episode is Winsorized at the 1st and 99th percentiles of the standardized AFP at the MS-DRG/APC-fiscal year level, during both the baseline year and the Performance Period in accordance with Appendix A of this Agreement.

  • Performance on these measures for each Clinical Episode by the Participant, if the Participant is a provider or supplier, as well as by Downstream Episode Initiators and Participating Practitioners, will be used to calculate the CQS and CQS Adjustment Amount for the Participant and, if the Participant is a Convener Participant, for each of the Participant’s Downstream Episode Initiators in the manner specified in Appendix A of this Agreement.

  • The Participant commits to identifying at least one Clinical from the Clinical Episode List.

  • If the date of discharge from the Anchor Stay occurs on or after the effective date of termination, the Participant will not be held accountable for the Clinical Episode for purposes of Reconciliation or the Post-Episode Monitoring Spending Calculation.

  • The performance period for this Agreement (“Agreement Performance Period”) is the only period of time during the Agreement Term during which a Clinical Episode may initiate.

  • A preliminary Episode Initiator-specific benchmark price for the Post-Episode Spending Monitoring Period will be calculated in the same manner as for the Episode Initiator-specific Target Prices calculated for each Clinical Episode, as described above.

  • CMS will provide the Participant with Target Price files on at least an annual basis, which will contain simple workbooks that display the preliminary Episode Initiator-specific Target Prices for each Clinical Episode.

  • The post-episode benchmark is calculated by applying the national Clinical Episode growth rate to the baseline.


More Definitions of Clinical Episode

Clinical Episode means the period of time described in Article 5.2 initiated on the first day of an Anchor Stay or an Anchor Procedure, during which all Medicare FFS expenditures for all non-excluded items and services furnished to a BPCI Advanced Beneficiary are bundled together as a unit for purposes of calculating the Target Price and for purposes of Reconciliation. Clinical Episodes may be initiated only during the Agreement Performance Period defined in Article 1.3.
View Source

Related to Clinical Episode

  • Phase III Clinical Trials means a Clinical Trial for the Product on sufficient numbers of patients to generate safety and efficacy data to support Regulatory Approval in the proposed therapeutic indication, conducted in accordance with current good clinical practices and in accordance with a protocol that has been reviewed by the FDA and reflects any comments or concerns raised by the same.

  • Phase 2 Clinical Trial means a human clinical trial of a product in any country that would satisfy the requirements of 21 C.F.R. 312.21(b) and is intended to explore a variety of doses, dose response, and duration of effect, and to generate initial evidence of clinical safety and activity in a target patient population, or a similar clinical study prescribed by the relevant Regulatory Authorities in a country other than the United States.

  • Clinical Trial means a Phase I Clinical Trial, Phase II Clinical Trial or Phase III Clinical Trial, or any post-approval human clinical trial, as applicable.

  • Phase III Clinical Study means a human clinical study of a product on a sufficient number of subjects that is designed to establish that such product is safe and efficacious for its intended use, and to determine warnings, precautions, and adverse reactions that are associated with such product in the dosage range to be prescribed, which trial is intended to support Regulatory Approval of such product, as described in 21 C.F.R. 312.21(c). 1.185. [***] 1.186. [***]

  • Phase 4 Clinical Trial means a Clinical Trial of a Product conducted after Regulatory Approval of such Product has been obtained from an appropriate Regulatory Authority, which trial is (a) conducted voluntarily by a Party to enhance marketing or scientific knowledge of the Product, or (b) conducted due to a request or requirement of a Regulatory Authority.