An episode of care under Medicare is 60 days.  Client may transfer and resume care during that 60 days and this will not change the duration of the 60 day episode.

 

Recertification is required to continue care for another episode of 60 days, at which point a new RAP will be submitted for the next episode of care.  The final billing is completed after the 60 days regardless of how many times a client transfers and resumes care with agency during the episode.

 

 

 

Our current system is billing per episode. So if someone has a transfer our system does not end the billing episode at that time. It still bills the regular originally designated episode. I was under the impression that a billing episode is SOC/ROC to REC/TRF/DC. So should a final claim go out when there is a transfer? And subsequently a RAP go out for a ROC starting a new billing episode?

 

Angela Aanenson RN COS-C

 

 

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