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EpisodeBased Cost Measure Development for the Quality Payment ProgramCenters for Medicare & Medicaid Services 12232016EXECUTIVE SUMMARY Introduction The Medicare Access and CHIP Reauthorization Act

How to fill out episode-based cost measure

How to fill out episode-based cost measure

1. Step 1: Gather all necessary data related to the episode-based cost measure, such as patient demographic information, medical procedure codes, and billing data.
2. Step 2: Identify the start and end dates of each episode for which the cost measure is being calculated.
3. Step 3: Calculate the total cost of each episode by summing up the costs of all relevant medical services, including hospital stays, surgeries, tests, medications, and any other related expenses.
4. Step 4: Normalize the cost data by adjusting for factors such as regional price variations or inflation.
5. Step 5: Calculate the average cost per episode by dividing the total cost by the number of episodes analyzed.
6. Step 6: Validate the accuracy of the data and calculations by conducting internal quality checks or seeking external audits if required.
7. Step 7: Document the methodology and assumptions used in the cost measure calculation process for transparency and reproducibility purposes.
8. Step 8: Communicate the results of the episode-based cost measure to stakeholders, such as healthcare providers, payers, policymakers, or researchers, to inform decision-making and healthcare improvements.

Who needs episode-based cost measure?

1. Healthcare providers: Episode-based cost measures can help healthcare providers identify care delivery patterns and variations in cost across different patient episodes. This information can support providers in optimizing resource utilization, improving patient outcomes, and managing costs effectively.
2. Payers: Insurance companies and other payers can utilize episode-based cost measures to assess the value and cost-effectiveness of healthcare services provided by various providers. This information can inform payer reimbursement strategies, provider network contracting decisions, and cost containment efforts.
3. Policymakers and regulators: Episode-based cost measures can assist policymakers and regulators in evaluating the performance of healthcare systems, identifying areas for improvement, and implementing evidence-based policies to enhance quality and affordability of care.
4. Researchers: Researchers studying healthcare costs, utilization patterns, or healthcare disparities can utilize episode-based cost measures to analyze and compare data across different populations, regions, or time periods. This can support the generation of robust research findings and inform policy recommendations.

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What is episode-based cost measure?

Episode-based cost measure is a method of calculating and reporting the costs associated with specific episodes of care, such as a hospital stay or surgery.

Who is required to file episode-based cost measure?

Hospitals and healthcare providers who participate in certain value-based payment programs are required to file episode-based cost measure.

How to fill out episode-based cost measure?

Providers can fill out episode-based cost measure by collecting data on costs related to specific episodes of care and reporting it to the relevant authorities.

What is the purpose of episode-based cost measure?

The purpose of episode-based cost measure is to track and analyze the costs of care for specific episodes, in order to improve the quality and efficiency of healthcare services.

What information must be reported on episode-based cost measure?

Providers must report information on the costs incurred during a specific episode of care, including hospital charges, physician fees, and other related expenses.