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"Medicare Fee-For-Service
2012 Supplemental QRUR: Episodes of Care
Episode Definitions"											
"Revised August 2014
"											
"Rationale and Feedback
A primary goal of the 2012 Supplemental Quality and Resource Use Reports (QRURs) is to provide actionable and transparent information that can support medical group practices in efforts to gauge and improve the efficiency of medical care provided to patients with certain medical conditions.  The episodes included contribute a high share of Medicare costs, have a large amount of variability in costs due to treatment decisions, and occur in multiple medical areas.  The episode information in the 2012 Supplemental QRURs is not used in calculating the Medicare Physician Fee Schedule Value-based Payment Modifier (VM).
The Centers for Medicare & Medicaid Services (CMS) is seeking feedback from stakeholders on the reports and included episodes. "											
Additional information can be found on this CMS website.											
"Defining Episodes
Episodes are constructed in three components: opening, grouping services, and closing. This workbook provides episode definition summaries and specific procedure, diagnosis, or service codes on Medicare claims used to open, or ?trigger,? an episode and group clinically related services to the episode for the 2012 Supplemental QRURs. While all codes listed in each table are used with rules to group clinically related services to the episode, only codes that are denoted with a ""Y"" in the third column of the code table can be used to open the episode."											
"Workbook Organization
The episode definition summaries and codes included in this workbook are presented in two worksheets for each ?major episode type.?  These two worksheets are: ?[Major episode name] Summary? and ?[Major episode name] Codes.? The Summary worksheets are text descriptions of the episode overview, any episode subtypes, and opening, grouping services, and closing rules.  Note that some major episode types include episode subtypes (e.g., pneumonia includes the subtypes with and without inpatient hospitalization).  The Codes worksheets include the full list of codes used to trigger and group services to the episode.  See the Table of Contents worksheet for the list of all major episode types and subtypes.   "											
End of Worksheet											
