Episode of care definition

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

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

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

EDH will also promptly coordinate and schedule Covered Services to be provided in connection with the anticipated Episode of Care among the Participant, the Provider(s) and, if applicable, any vendors of Travel Services.
If at any time during an Episode of Care, a Provider determines that any Medically Necessary Service must be performed on an urgent or emergency basis to preserve the life or health of the Participant, Sponsor will be responsible for payment of the Provider’s charges for any such Medically Necessary Service as part of the Episode of Care.
If applicable, a Provider will establish treatment protocols for an Episode of Care and, if needed, the Provider will modify such protocols for a Participant.
Following Provider’s initial review of Participant’s medical records and information, and subject to a physical examination and medical assessment of Participant, as determined necessary by a Provider, a Provider will confirm to EDH whether or not, in Provider’s independent medical opinion, Participant is a suitable candidate for Covered Services during an Episode of Care at a Provider’s location, and Provider will advise EDH of the Diagnosis Case Code related to such Episode of Care.
If a Participant, for any reason, is not admitted by a Provider, or if a Participant cancels a scheduled procedure at any time prior to performance of the Episode of Care, then Sponsor shall be responsible for the cost of Provider’s review of Participant’s medical records, the cost of any pre-admission testing or treatment provided by a Provider, and any expenses related to Travel Services.

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 [client] member has been discharged by the provider or there has been [an extended] a cessation in treatment [defined as] of not less than 120 days [from the last time] after the [client] member was treated at the clinic;

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;