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Set up a billing episode

Billing episodes identify the primary payor, disciplines, and dates RehabAlpha uses for therapy services tied to an admission. The primary payor determines the reimbursement model.

Before you start​

Confirm that you have:

  • An admission.
  • An organization payor.
  • A facility billing-provider rule and reimbursement arrangement that cover the episode dates.
  • The correct discipline or disciplines for the therapy services being billed.

Add a billing episode​

  1. Open the patient's admission.
  2. Find Billing episodes.
  3. Click Add billing episode.
  4. Select the Primary payor. The selection shows the payor's payment model type.
  5. Select the discipline or disciplines.
  6. Enter the start and end of the period.
  7. For PDPM case-mix per diem, select the skilled nursing facility service location.
  8. For PDPM case-mix per diem, enter the initial stay day and initial benefit day. Most stays start with 1 for both fields.
  9. For PDPM case-mix per diem, add any interrupted-stay periods when the patient temporarily leaves Part A-covered SNF care and returns within the interrupted-stay window.
  10. For Custom fee schedule, Duration-based payment, or Medicare Part B MPFS, select a default service location when appropriate.
  11. Save the admission.

You should know​

For PDPM case-mix per diem, the initial stay day controls PDPM variable per-diem adjustment factors. The initial benefit day tracks the patient's 100 Medicare Part A SNF benefit days.

These numbers are usually the same, but they can differ when Medicare treats a return as a new SNF stay while the same Part A benefit period continues.

For PDPM case-mix per diem, interrupted-stay periods represent non-covered dates inside the same Medicare Part A stay. RehabAlpha skips those dates in the Part A revenue table and resumes stay day and benefit day counting on the next covered SNF day.

When the patient returns after the interrupted-stay window or to a different SNF, add a new PDPM case-mix per diem billing episode instead of extending the same one.

The billing episode stores a snapshot of the selected primary payor's ID, name, type, and the payor's payment model type. Later changes to the payor's name or type do not change the saved snapshot. The payment model type itself cannot be edited on the payor.

Patient coverages remain separate patient-specific records for dates, benefits, and authorizations. Billing episodes do not select or sequence patient coverage records.

When you save, RehabAlpha verifies that the facility has a billing-provider rule and a reimbursement arrangement matching the payor's payment model type throughout the episode. The billing provider and arrangement can change over time when consecutive effective periods cover the full date range.

When to add another billing episode​

Add a new billing episode when the responsible payor changes, the episode period ends, a managed care plan begins, or the patient moves from one billing arrangement to another.