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Set up billing episodes

Billing episodes identify the primary payor, billing mode, disciplines, and dates RehabAlpha uses for therapy services tied to an admission.

Before you start​

Confirm that you have:

  • An admission.
  • An organization payor with the correct payment model.
  • The correct discipline or disciplines for the therapy services being billed.
  • The billing mode: Direct billing or Contract therapy.

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 payor's payment model determines which additional fields appear.
  5. Select the Billing mode.
  6. Select the discipline or disciplines.
  7. Enter the start and end of the period.
  8. For SNF Part A, select the skilled nursing facility service location.
  9. For SNF Part A, enter the initial stay day and initial benefit day. Most stays start with 1 for both fields.
  10. For SNF Part A, add any interrupted-stay periods when the patient temporarily leaves Part A-covered SNF care and returns within the interrupted-stay window.
  11. For Outpatient Part B, select a default service location when appropriate.
  12. Save the admission.

You should know​

For SNF Part A, 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 SNF Part A, 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 SNF Part A billing episode instead of extending the same one.

The billing episode stores the selected primary payor's ID and its payment model. Editing the payor's name or type is reflected wherever the episode displays current payor details. The episode's payment model remains unchanged until the billing episode is edited.

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

For Contract therapy, RehabAlpha resolves the billing provider from facility contracts that match the billing episode's primary payor and dates. The resolved provider can change during the billing episode when consecutive contracts apply. For Direct billing with an Outpatient Part B payor, you can optionally select a Presumed billing provider. RehabAlpha records that provider as the planned billing-provider context. Billing mode and the presumed provider do not yet select a fee schedule or change the estimated amount.

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.