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Payment models overview

A payment model describes a financial arrangement for one party to pay another party. In RehabAlpha, payment models describe how therapy services are reimbursed. RehabAlpha supports these payment models:

Payor payment model vs contract payment model​

RehabAlpha uses two kinds of payment models:

  • A payor payment model describes the manner in which a payor reimburses a billing provider (facility) for therapy services.

  • A contract payment model describes the manner in which a facility reimburses a therapy company for therapy services.

These payment models answer different questions. A payor payment model answers, “How much does the payor owe the billing provider for services?” A contract payment model answers, “How much does the facility owe the therapy company for services?” If your organization provides only outpatient therapy, you will typically use only payor payment models. If your organization provides contract therapy, you may need to use both.

Payor payment models​

In RehabAlpha, every payor must have a payment model.

The payment model controls parts of the clinical workflow. For example, it determines whether therapists see a units progress bar when completing a treatment service log and whether Section GG assessment items appear in an evaluation.

To specify how much a payor reimburses for therapy services, add a payor arrangement to the payor. The arrangement contains the settings for that payment model. For example, for a payor that uses a custom fee schedule, the arrangement selects the fee schedule to use. You can select different fee schedules for different billing providers. For a payor that uses duration-based payment, the arrangement sets a dollars-per-minute rate for each covered discipline.

Contract payment models​

In RehabAlpha, a facility contract defines how a facility reimburses a therapy company for therapy services. A contract can include one or more payment terms. Each payment term defines the amount the facility pays when its conditions are met.

Each payment term uses one of these arrangements:

  1. Percent of payor reimbursement: The therapy company receives a percentage of the amount the payor is obligated to reimburse the facility.
  2. Contract payment model: The therapy company defines its own payment rules for the facility. The amount the payor reimburses the facility does not determine the contract payment.

Choose the approach that matches how your therapy company is paid:

  1. Base payments on payor reimbursement. Configure a payor arrangement for each payor so RehabAlpha can calculate the amount the payor reimburses the facility. Then use a percent-of-payor-reimbursement payment term to calculate what the facility owes the therapy company.

  2. Use contract payment models only. Don't configure payor arrangements. Instead, use contract payment models to define what each facility pays the therapy company.

  3. Use both approaches. Configure payor arrangements to see what the facility receives from payors, while using contract payment models to define the facility's payment to the therapy company. These payment amounts can differ.