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Set up coverage episodes

Coverage episodes tell RehabAlpha which coverages should be billed for therapy services tied to an admission.

Before you start​

Confirm that the patient has:

  • an admission
  • at least one coverage
  • the correct discipline or disciplines for the therapy services being billed

Add a coverage episode​

  1. Open the patient's admission.
  2. Find Coverage episodes.
  3. Click Add coverage episode.
  4. Select the payment model.
  5. Select the coverages responsible for payment.
  6. Select the discipline or disciplines.
  7. Enter the start date.
  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. Enter the payment split or order required by your billing workflow.
  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 coverage episode instead of extending the same one.

When to add another coverage episode​

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