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Custom fee schedule

Use the Custom fee schedule payment model when reimbursement is based on rates in one of your organization's fee schedules. You can use this model for either of these financial relationships:

  • A payor reimburses a billing provider for therapy services.
  • A facility reimburses your therapy organization for therapy services under a contract.

These workflows are independent. You can use either one or both, depending on which financial relationships your organization needs to track.

Before you start​

Create an organization fee schedule with the CPT rates you want to use.

For a payor reimbursement arrangement, create the payor with Custom fee schedule selected as its payment model. A payor's payment model cannot be changed after the payor is created.

For a facility contract, you do not need to select Custom fee schedule on the payor. The contract payment model is configured separately and can apply to payors using any payor payment model.

Set up a payor reimbursement arrangement​

  1. Open the payor.
  2. Click Reimbursement arrangements.
  3. Click New reimbursement arrangement.
  4. Enter the arrangement period and choose the billing providers it applies to.
  5. Under Payment details, select the Fee schedule.
  6. Enter the Adjustment percent.
  7. Choose whether to include the assistant payment reduction when a CO or CQ modifier applies.
  8. Click Save.

Use separate, non-overlapping arrangements when the applicable fee schedule or payment terms change over time.

Set up a facility contract payment term​

  1. Open the facility.
  2. Click Contracts.
  3. Click New contract.
  4. Enter the contract dates and add a contract payment term.
  5. In Step 1: Choose how the facility pays [your organization name], select Contract payment model, and then select Custom fee schedule.
  6. In Step 2: Choose payors, choose all payors or filter by payor type or specific payors.
  7. In Step 3: Configure the contract payment model, select the Fee schedule.
  8. Add percentage rules for specific CPT codes or disciplines when needed, and enter the required fallback percentage.
  9. Click Save.

For each service line, RehabAlpha applies the first matching percentage in this order: CPT code, discipline, and then the fallback percentage. It applies that percentage to the selected fee schedule's effective CPT rate and the billed units. This calculation is independent of the payor's reimbursement arrangement.