Skip to main content

Set up a billing provider

In RehabAlpha, a billing provider is the legal entity identified for billing. One billing provider is set per billing episode. A facility can set reasonable rules for automatically picking the default billing provider for a billing episode based on the primary payor.

For contract therapy at a skilled nursing facility (SNF), Medicare's SNF consolidated billing requirements make the SNF—not the contracted therapy company—responsible for billing Medicare for therapy services subject to consolidated billing. In other settings, such as outpatient therapy, the billing provider may be different.

Is this necessary / why does this matter?

Setting up a billing provider is not necessary unless you want RehabAlpha to calculate payor reimbursement. Even then, it is only needed for some reimbursement scenarios. The most common is Medicare Part B, which uses billing provider attributes—particularly participation status—to determine reimbursement rates.

Before you start​

You need:

Understand billing providers​

In RehabAlpha, billing providers exist at the top level of an organization, just like facilities and payors.

For Medicare consolidated billing, you will typically set up one billing provider for each skilled nursing facility (SNF). Set up a separate billing provider for your therapy company to submit claims for outpatient services.

Set billing provider defaults for a facility​

After creating organization billing providers, add ordered facility rules that choose a default for new or changed billing episodes:

  1. Open Facilities and select the facility.
  2. Click Settings.
  3. Click Add rule.
  4. Select a Billing provider.
  5. Choose Specific payors and select one or more payors, or choose All payors.
  6. Add more rules as needed.
  7. Drag the cards into priority order. RehabAlpha uses the first card that matches the selected payor, so a card above another matching card overrides it.
  8. Click Save.

Specific-payor cards can include multiple payors and can overlap. Use their order to decide which provider wins. You can add at most one All payors card. Place it below specific rules to use it as a fallback; placing it above them causes it to override them.

These rules provide defaults only. A user can select a different provider or clear the provider on an individual billing episode. Reordering or editing the rules does not change saved episodes. Payor arrangements remain part of the payor setup.

Create a billing provider​

  1. Open Billing providers.
  2. Click New billing provider.
  3. Enter the billing provider Name.
  4. Enter the National Provider ID (NPI) when available.
  5. Enter the Federal Tax ID when available.
  6. Enter the Taxonomy code when available.
  7. Select the Medicare Part B participation status when it applies to the billing provider.
  8. Enter the Billing address, including street address, city, state, ZIP code, and ZIP+4 when available.
  9. Add tags or notes when helpful.
  10. Click Save.

RehabAlpha creates the billing provider and adds it to the organization's billing provider list.

Manage billing providers​

  1. Open Billing providers.
  2. Find the billing provider in the list.
  3. Click the billing provider name.
  4. Click Details.
  5. Click Edit.
  6. Update the basic details, billing address, tags, or notes.
  7. Click Save.

Delete a billing provider​

  1. Open the billing provider.
  2. Click Settings.
  3. Click Delete billing provider and confirm the deletion.

You must first remove the billing provider from facility default rules and any reimbursement arrangements that select it. Existing billing episodes keep their saved provider snapshots.

You should know​

Only admins can add or delete billing providers.

Create separate billing provider records when your organization bills under different legal providers, NPIs, tax IDs, taxonomy codes, or billing addresses.

Frequently asked questions​

Is a billing provider the same as a facility?​

No. A facility is where care is delivered. A billing provider is the provider or company identified for billing. One organization may have one billing provider or multiple billing providers depending on how billing is structured.

Is a billing provider the same as a therapist or physician?​

No. Therapists and physicians are people who appear in clinical, scheduling, signature, or staffing workflows. A billing provider is an organization-level billing record.

Can I create more than one billing provider?​

Yes. Create multiple billing providers when your organization needs distinct billing identities, such as different legal names, NPIs, tax IDs, taxonomy codes, or billing addresses.

Where do I enter payor or patient coverage details?​

Enter payor details in Payors and patient-specific coverage details in patient coverage. Billing provider records store the provider identity used for billing.

What to do next​

After setting up the billing provider, add facility default rules when helpful. Then set up payors and add patient coverage as needed.