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Medicare Part B MPFS

Use Medicare Part B MPFS when reimbursement follows the Medicare Physician Fee Schedule payment approach for outpatient therapy services. 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.

Before you start​

For a payor reimbursement arrangement, create the payor with Medicare Part B MPFS selected as its payment model. A payor's payment model cannot be changed after the payor is created.

For a facility contract, the contract payment model is configured separately. It can apply to payors using Custom fee schedule, Duration-based payment, or Medicare Part B MPFS, but not PDPM case-mix per diem.

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, enter the Adjustment percent.
  6. Choose whether to include MPPR.
  7. Choose whether to include the assistant payment reduction when a CO or CQ modifier applies.
  8. Click Save.

MPPR reduces the practice-expense portion for applicable therapy services after the highest practice-expense unit on the same patient service date.

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 Medicare Part B MPFS.
  6. In Step 2: Choose payors, choose all eligible payors or filter them by payor type or specific payors.
  7. In Step 3: Configure the contract payment model, enter the Therapy organization revenue share percent and choose whether to include MPPR, the assistant payment reduction, and sequestration.
  8. Click Save.

The contract calculation always uses CMS Medicare Physician Fee Schedule data, even when the payor's reimbursement arrangement uses an organization fee schedule. RehabAlpha applies the selected reductions, includes the patient's 20% responsibility in expected collected revenue, and then applies the therapy organization revenue-share percentage.