Episode of Care
An Episode of Care is the full set of services a patient receives for a single condition or procedure across a defined period and settings. In bundled-payment models, it anchors how ambulatory surgery centers and providers are reimbursed.
What is an Episode of Care?
An Episode of Care is the complete set of services a patient receives for a single condition or procedure over a defined time and, often, across multiple settings. It frames care as a connected sequence rather than a series of unrelated encounters.
An episode might span pre-procedure evaluation, the procedure itself, and the follow-up and recovery that surround it. Defining the boundaries of an episode, what it includes and over what window, is central to how the concept is used.
What role does an Episode of Care play in the revenue cycle?
In bundled-payment models, the episode of care is the unit that reimbursement is built around: providers receive a single, predetermined amount for the whole episode rather than separate payments for each service. This shifts financial responsibility for the full course of care onto the participating providers.
For ambulatory surgery centers operating under such arrangements, understanding which services fall inside an episode is essential to managing cost and margin. Accurate tracking of everything tied to an episode determines whether the facility performs well financially under the bundle.
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