The documents on this page contain technical information about each episode type:
- The Detailed Business Requirement (DBR) document serves as a guide to understand the definition of an episode. You can find each episode’s DBR in the Searchable Episodes Table.
- The Configuration File contains the parameters and medical codes needed to define the episode. You can find each episode’s Configuration File in the Searchable Episodes Table.
- The episode Summary provides an overview of the episode design for quick reference. Episode summaries are included in both the Searchable Episodes Table and Episodes by Wave.
- The Episodes of Care Cost and Quality Thresholds document provides an overview of the thresholding process and annual values used to calculate gain-sharing or risk-sharing payments for accountable providers.
Cost and Quality Thresholds
- 2021 Episodes of Care Thresholds
- 2020 Episodes of Care Thresholds
- 2019 Episodes of Care Thresholds
- 2018 Episodes of Care Thresholds
Managed Care Organizations (MCOs) are responsible for the risk adjustment of episode costs. An episode’s risk-adjusted cost is the episode cost divided by a risk weight for the specific episode. The risk weight adjusts the cost of that episode. Each risk factor has an individual risk weight that is published on each MCO’s website:
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