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Duration-based payment

Use Duration-based payment when reimbursement is based on a dollar amount per billing unit. 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​

For a payor reimbursement arrangement, create the payor with Duration-based payment 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 Duration-based payment 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, choose Custom units or Medicare units.
  6. For custom units, enter Minutes per unit and choose how to round units.
  7. Add dollar-per-unit rates for CPT codes when those codes need their own rates.
  8. Add fallback rates by discipline for services not covered by a CPT rule.
  9. Enter the required fallback rate for services that match neither a CPT nor discipline rule.
  10. Click Save.

Medicare units use the Medicare 8-minute rule. When rates could match more than one rule, RehabAlpha uses a CPT-code rule first, then a discipline rule, then the fallback rate.

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 Duration-based payment.
  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, choose Custom units or Medicare units.
  8. For custom units, enter Minutes per unit and choose how to round units.
  9. Add dollar-per-unit rules for CPT codes or disciplines when needed, and enter the required fallback rate.
  10. Click Save.

For each service line, RehabAlpha applies the first matching rate in this order: CPT code, discipline, and then the fallback rate. This calculation is independent of the payor's reimbursement arrangement.