Unlike many private insurers, Medicare has specific rules and regulations that need to be followed. This is because Medicare is government funded, and is therefore subject to oversight by government bodies. As such, the Medicare rule of 8 was created with the intention of reducing fraud and overbilling. However, that is not always the case. With the 8 minute rule, physical therapy providers are made to treat patients for a minimum of eight minutes to be able to bill Medicare for their services. Read on to learn about how this works in practice.
Understanding Billing Units
Because this is a government system, is it created into a neat and codified system. For one, billing units are in 15 minute increments, but you cannot bill for a treatment if it is less than 8 minutes long. Hence, the name Medicare rule of 8. However, in order to bill for a unit, it needs to be direct, skilled care that is administrated for on a one-on-one basis. So, if you have a physical therapy assistant helping a patient bill for something basic, you cannot bill for that time. Instead, a billing unit based on a time code needs to for direct therapeutic services, and cannot include your patient changing, waiting for machines, or any administrative time.
If you do not follow this metric, and regularly work with Medicare, you are risking a potential audit. As such, you need to make sure that all units you are billing for are focused on a particular type of therapy, and any therapy administered within an 8 minute to 22 minute period. Every 15 minute increment thereafter can be billed as a separate unit. However, do keep in mind that if you perform multiple services and they don’t fit neatly into billing units, you will need to roll the extra time into a specific physical therapy in order to be reimbursed for this service. Typically, you’ll want to roll it into the service that you’ve performed the most during that session in order to have the maximum chance of being reimbursed.
Physical therapists that work regularly with Medicaid and other federal bodies need to understand the 8 minute rule so as to not run afoul of any rules and regulations. While it can seem confusing or daunting at first, hopefully this article has helped in your understanding of how to bill with a CPT time code and has cleared up any confusion that you may have had around this process.
Ultimtealy, running a physical therapy practice is a challenge, and medical billing is only one facet of that. Having a greater understanding of how you can best perform physical therapy both for patient care and reimbursement is crucial to your success as a physical therapist. If you ignore one side too heavily, you may find that you’ll be under-billing, or scaring away customers and ruining your reputation due to over-billing and nefarious practices. As such, it is best that you find a balance between the two, and understanding regulations like the Medicare rule of 8 is crucial in this.