Define an 'episode of care' in episode-based payments.

• A. It is a single hospital stay billing unit only.
• B. It is any service provided within 24 hours of admission.
• C. It covers all related services for a specific clinical condition or procedure over a defined period across care settings.
• D. It refers to preventive services only.

Answer: (C)

An episode of care in episode-based payments is a bundled set of all related services tied to treating a specific clinical condition or performing a specific procedure, captured over a defined period and across care settings. It typically begins with a trigger event, such as hospital admission for the condition or the execution of the procedure, and ends after the defined window to include follow-up care, post-acute services, and any related complications. The goal is a single bundled payment that covers everything needed for that episode, encouraging care coordination and reducing unnecessary variation.

This description fits best because it embraces the full scope: all services linked to a particular condition or procedure, over a defined timeframe, across different settings. It’s not limited to a single hospital stay, not restricted to a 24-hour window, and not focused only on preventive services.