This machine learning device optimizes the patient's entire episode of care
by enabling a proactive approach.
This free service helps medical professionals and hospitals navigate Medicare's new payment model while providing them with the resources they need to optimize the management of patient outcomes, costs, and satisfaction across the total episode of care
CJR hospitals are now reimbursed a set amount for the entire 90-day episode of care
Healthcare providers, like never before, face the challenge of complete financial ownership for the entire episode of care
for hip and knee replacements," said Roger Shaul, President at PMMC.
kijt] denotes each patient's characteristics, including age, gender, race, participation in the Medicare Buy-in program, clinical and functional severity, an indicator whether each patient was on first/second or third and after episode of care
, an indicator of whether each patient stayed in an acute-care setting prior to a home health admission, and indicators of most frequent health diagnoses.
Instead, payers designate a single caregiver or entity to serve as the principal accountable provider, or PAP, with responsibility for managing the cost and quality for an episode of care
The patient is with the same therapist throughout any given episode of care
Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an episode of care
for a specific condition.
An episode of care
may refer to all services, including hospital, physician, and other services related to a health condition with a given diagnosis from a patient's first admission, including any readmissions, through the last encounter for the condition, including postacute services such as home health, skilled nursing facility, and rehabilitation.
Another proposal would encourage greater cooperation by bundling payments to hospitals to cover all costs associated with a particular episode of care
for a patient.
While clinical coding is not the sole axis for private hospital invoicing, private sector coders need to be aware of the basic tenets of the contracts in order to ensure that the coding accurately reflects the episode of care
to be billed.
The Government previously stated that patients cannot mix and match private and NHS care, with current rules being that a patient cannot be both an NHS patient and a private patient in the same episode of care