Treat Episode as Discharged

This rule instructs the system to treat a patient's treatment episode as discharged when creating an institutional claim. 

Workflow

Let's review how to create a claim rule instructing the system to treat a patient's treatment episode as discharged!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Form  Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Institutional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select Treat Episode As Discharged.
     
     
  9. Next, click Add.
     
  10. Slide the toggle to Yes.
      
  11. To create multiple behaviors, repeat steps 7-10.
  12. Click Save to complete the process.
       

Box Number(s)

• UB-04: N/A
• CMS-1500: N/A

Helpful Hints

• This condition will write the discharge hour to the claim if the patient is discharged. It can also be used to ensure a claim rule will write other discharge information to the claim, e.g. discharge status, discharge hour.
• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.