Explaining the 8 Minute Rule for Medicare Physical Therapy Billing

There are many industries that have changed since the turn of the century. This is because technology has progressed quite a bit, and as a result of the increased rule of computing in society, things are much more measured and actionable than they have been in the past. One such area that has been disrupted in this way is healthcare. In that sense, healthcare is at the forefront of industries that have been changed and more accurately measured through the use of technology. This also applies to medical billing, which has changed to fit the modern data-driven era. With that in mind, here is how Medicare has currently changed the way that medical billing works for physical therapy.

Breaking Down the 8 Minute Rule

Simply put, the 8 minute rule is the way that Medicare determines how healthcare providers can bill for physical therapy. This is differentiating from how healthcare providers can bill private insurance in that its actionably measured and needs to be recorded. Medicare is also stricter about how it can be billed, as the money is coming directly from taxpayers for this service. As such, understanding exactly how the 8 minute rule for Medicare works is of paramount importance, lest you want to risk fines or penalties from the government.

To understand the 8 minute rule, you need to break down all of your care into billing units. In terms of physical therapy care, a billing unit is defined as a unit of care between 8 and 22 minutes. This care needs to be solely administered by a physical therapist, meaning that care provided by physical therapy assistants or time spent waiting for machines, billing, or appointment-making cannot be rolled into a billing unit.

However, that doesn’t mean that you can’t bill for more than one billing unit per activity. For example, if you are focusing on a specific area of the body or machine, and your client needs to anywhere between 23 and 37 minutes of care in that area, then you can bill Medicare for 2 billing units. That being said, you can also roll over billing units into a dominant activity if you perform one for 22 minutes and another for 5, which would not qualify for a billing unit. In that case, you can roll over both and charge for 2 billing units.

With a measured system in place that is meant to be fair as possible to both the patient and the healthcare provider, Medicare billing can certainty be complex. However, once you understand how the 8 minute rule works for physical therapy billing, then you’ll have a better understanding of how to correctly bill Medicare for your work. Once you get a better handle on this, you’ll find that patients who come in via Medicare could be recurring at a much higher rate, as they likely have much more chronic physical ailments that need more regular treatment. This can help with your revenue as a physical therapy practice – but only if you correctly bill Medicare and apply the 8 minute rule to all of your Medicare patients.