Episode of care definition

Episode of care means a period of continuous hospital treatment, including readmission within a seven

Episode of care means a specific medical problem, condition, or specific illness being managed including tests, procedures, and rehabilitation initially requested by the health care practitioner, to be performed at the site of service, excluding out of network care: Provided, That any additional testing or procedures related or unrelated to the specific medical problem, condition, or specific illness being managed may require a separate prior authorization.

Episode of care means services provided to a patient by a health provider that:

Examples of Episode of care in a sentence

• Once the Episode of Care maximum has been met or the Covered Person has reached any additional approved visit maximum established, no additional physical therapy benefits will be provided for that condition.

• If a diagnosis is not provided and there are no claim attachments or other claims for the Episode of Care (EOC) from which a diagnosis can be determined, the claim shall be processed using an unlisted diagnosis.

• The APAD is also not payment for LARC Devices or for APAD Carve-Out Drugs, which may be paid separately as described in Section 5.B.8. The APAD is calculated as set forth in Section 5.B.1.Adjudicated Payment per Episode of Care (APEC) – a Hospital-specific, Episode-specific all-inclusive facility payment for all APEC-Covered Services provided by a Hospital to a MassHealth Member on an outpatient basis in one Episode.

• For services that qualify for the Rehabilitation Unit per diem, the Psychiatric Per Diem, the Administrative Day per diem, or the Adjudicated Payment Per Episode of Care (APEC), the Hospital’s MassHealth rates and payment methods established prior to this RY19 RFA apply to dates of service prior to November 1, 2018, and the Hospital’s RY19 RFA rates and payment methods apply to dates of service on or after November 1, 2018.

• Except as otherwise provided for Outpatient Services specified in Section 4.C and Sections 5.C.3 through 5.C.8, Hospitals that are not Critical Access Hospitals will receive a Hospital-specific, Episode-specific payment for each payable Episode, known as the Adjudicated Payment per Episode of Care (APEC), calculated as set forth in Section 5.C.1, below.

More Definitions of Episode of care

Episode of care means (i) all services rendered by a SurgeryPlus network provider and provider’s professional and medical staff, as applicable and (ii) all hospital- or facility-related expenses under the diagnosis case code. The Episode of Care begins on the day the patient first receives services from the provider related to the diagnosis case code and ends when the patient is discharged from the hospital or facility to return or travel home. Services and expenses under the diagnosis case code commonly included in the Episode of Care are equipment used while in hospital or facility, in-hospital or in-facility medications or biologics and supplies, implants, labs, in-hospital meals, hospital confinement days, pre- and post in-hospital or in-facility nursing care, in-hospital physical therapy and follow-up consultations, and any other medically necessary care related to the diagnosis case code rendered prior to discharge. An Episode of Care shall not include

Episode of care means a specific medical problem, condition, or specific illness being

Episode of care means medical services, nursing services, or health-related services provided by a health care institution to a patient for a specific period of time, ending in discharge or the completion of the patient’s treatment plan, whichever is later.

Episode of care means medical services, nursing services, or health-related services provided by a hospital to a patient for a specific period of time, ending with a discharge.

Episode of care means the medical care ordered to be provided

Episode of care means a period of care that ends when the member has been discharged by the provider from receiving outpatient hospital services or when there has been an extended cessation in treatment not less than 120 days from the last time the member was treated at the hospital;

Episode of care means a period of consecutive days— ‘‘(i) beginning with the first day on which a veteran