Billing overview
In therapy operations, billing can mean two different reimbursement workflows. RehabAlpha supports revenue-cycle setup and reimbursement calculations for both contexts, but it does not currently submit claims to payors or manage direct billing.
Two meanings of billing
Facility reimbursement to a therapy company
In a contract therapy arrangement, a therapy company furnishes services for a facility. The facility reimburses the therapy company according to their contract. RehabAlpha can calculate the facility's financial obligation and create facility invoices for this workflow.
This workflow applies only to contract therapy. If you operate a small outpatient clinic or an in-house therapy department, you will generally not use facility contracts or facility invoices.
Payor reimbursement to the billing provider
In the other workflow, a payor reimburses the billing provider—typically the facility—for covered therapy services. RehabAlpha uses payors, reimbursement arrangements, billing-provider rules, and billing episodes to determine the applicable payment model and calculate reimbursement information.
This is the reimbursement relationship most outpatient clinics recognize. It is separate from any contract between a facility and a therapy company.
Service documents
RehabAlpha supports five kinds of clinical documents, three of which are considered service documents:
| Clinical document | Is also a service document? |
|---|---|
| Evaluation | ✅ Yes |
| Treatment | ✅ Yes |
| Progress report | ❌ No |
| Re-evaluation | ✅ Yes |
| Discharge | ❌ No |
A service document is a clinical document that includes a service log.
Service logs and service items
A service log is a record of CPT-coded services provided during the evaluation / treatment / re-evaluation. Each entry in the Service log is a service item. It records the CPT code and relevant service details, such as minutes and notes.
For example, a treatment can include these service items:
| CPT code | Service | Minutes | Notes |
|---|---|---|---|
| 97110 | Therapeutic exercises | 20 | Strengthening program |
| 97530 | Therapeutic activities | 15 | Transfer practice |
Many (but not all) payors use these service items to calculate reimbursement.
Service-day billing details
Billing details brings together the service items for one facility, patient, payor, and service date. It exists because reimbursement rules can apply across all of a patient's services for a day, rather than to each clinical document separately.
For example, if a patient has two treatment documents on the same day, each with a 97110 service item, billing details retains both source items and can aggregate them when it calculates units and reimbursement.
The diagrams below show how admissions and billing episodes lead to service-day billing details.
Facility, patient, and admissions
Recall, an admission is a link between a patient and a facility over a time period. A patient can have multiple admissions (even to the same facility).
Billing episodes within an admission
A single admisson can have multiple billing episodes. A billing episode answers the question "Who's paying for therapy services, over which time period, and for which disciplines?"
Payors, disciplines, and therapy cases
Service-day billing details
Each facility, patient, payor, and service-date combination has its own service-day billing details. For example, services for two payors on the same date remain in separate groups:
Admin users can open Billing details from the Services or interventions provided today section of a service document. In the dialog, review:
- Summary: The facility, patient, payor, payment model, mapped reimbursement arrangement, billing provider, service date, and calculated payor reimbursement.
- Service items: Every source service item included in the service-day calculation.
- Payor reimbursement: The calculated service-item units and reimbursement details. Claim modifiers are applied and displayed at this service-day unit level.
Revenue cycle management in RehabAlpha
RehabAlpha supports these major revenue cycle management (RCM) components:
- 🏢 Billing-provider and payor setup: Record the billing identity and the payors your organization works with. See Set up a billing provider and Set up a payor.
- 🪪 Patient coverage and authorizations: Track patient-specific coverage periods, benefits, and authorization details. See Set up a patient coverage.
- 🗓️ Billing episodes: Identify the primary payor, disciplines, and dates that apply to an admission. See Set up a billing episode.
- 💵 Reimbursement arrangements and payment models: Configure how a payor reimburses a billing provider, including fee schedules and supported payment models. See Set up a fee schedule and Payment models overview.
- 🤝 Facility contracts and invoices: For contract therapy, calculate what a facility owes the therapy company and create an invoice. See Set up a facility contract and Set up a facility invoice.
RehabAlpha does not currently prepare, submit, or manage claims and remittances between the billing provider and payor. Use RehabAlpha's billing setup and reimbursement information to support your revenue-cycle workflow, then complete claim submission and payor-payment processing in your current billing system.
What to do next
Start with Set up a billing provider and Set up a payor. Then add patient coverage and billing episodes for the admissions you manage in RehabAlpha.