The 8-minute rule states that a therapist must provide treatment for at least eight minutes and that for billing purposes, billing units can be standardized to units of eight. This is an efficient way for physical therapists to bill Medicare and figure out how many units they should bill for. It also benefits patients because it means that they will receive the best possible care.
The 8-minute Medicare billing rule
The 8-minute rule is important for physical therapists to understand because it can impact how they bill Medicare and, ultimately, how much money they make. It is also important for patients to be aware of this rule so that they can evaluate the quality of care they receive and understand how billing works in general.
How does Medicare billing 8-minute rule work?
Normally, when a physical therapist provides care to a Medicare patient, they will submit a claim to Medicare. This claim will include the number of minutes that the therapist provided care, as well as the type of care provided.
However, under the 8-minute rule, therapists must provide at least 8 minutes of care in order for it to be billable. This means that if a therapist only provides care for six minutes, they will not be able to bill Medicare for that time.
When they bill Medicare, they can use 8-minute increments to determine how many units to bill. For example, if a therapist provides care for 16 minutes, they can bill for two units.
What are the benefits of the 8-minute rule?
The 8-minute rule is beneficial for both patients and therapists.
Patients get the best care possible
Sometimes receiving healthcare and physical therapy can feel like a numbers game. How many patients can be seen in a day? How many minutes should be spent with each patient? The 8-minute rule puts an end to this debate. By making sure that therapists provide at least 8 minutes of care, patients can be sure that they are receiving high-quality treatment. This rule also allows therapists to provide more comprehensive care.
For example, if a patient is seen for 15 minutes, the therapist can provide a full assessment and create a treatment plan. If the patient is only seen for 8 minutes or less, the therapist may not have enough time to do this.
Therapists can manage Medicare easier, saving time and money
Operating a physical therapy practice can be expensive, and therapists need to be able to bill for their services in order to stay afloat. The 8-minute rule makes it easier for therapists to handle their finances, as they can use a minimum time of treatment as a general rule and simple increments to determine how many units to bill.
This is a big benefit because it can save therapists a lot of time when billing. In addition, it can also save money because therapists will not have to bill for smaller increments of time, which can add up.
What are the drawbacks of the 8-minute rule?
There are a few drawbacks to the 8-minute rule. First, it can be difficult to keep track of how many minutes you have provided care for. Secondly, if you only provide care for six minutes, you will not be able to bill Medicare for that time.
These drawbacks are not major, and the 8-minute rule still provides many benefits for both patients and therapists. Overall, the 8-minute rule is a good way to ensure that patients receive good care and that therapists can bill easily.
What is the 8-minute rule chart?
An 8-minute rule chart is a tool that physical therapists can use to help them understand how many units of care they should provide and how to bill for those units.
For example, if a therapist provides care for 16 minutes, they can bill for one unit. Medicare adds the total number of therapy minutes and divides the total by 15 to find the number of billable units.
Then, if there are 8 or more minutes that are left after the division, the therapist can bill for one additional unit. However, if there are seven or fewer units left at the end of the calculation, you can’t bill for any extra units.
Overall, the 8-minute rule chart is a helpful tool for physical therapists and administrative staff to understand how to bill for care.
The 8-minute rule Medicare Part B
Medicare Part B is a federal program that provides health insurance for seniors and people with disabilities. Part B covers medically necessary services, such as doctor visits, laboratory tests, and physical therapy, among others.
Thus, the 8-minute rule applies to Medicare Part B services, so if you are a therapist who provides such services, be sure to follow the 8-minute rule.
Time-based CPT codes
The 8-minute rule Medicare implemented only applies to the time-based CPT codes. These are the codes that are based on the amount of time spent providing care. The 8-minute rule does not apply to other CPT codes, such as those for evaluation or assessment.
There are three code categories for CPT codes:
Category 1: all services and procedures
Category 2: any performance management
Category 3: some emerging and experimental services and procedures
Time-based coding guidelines are different from service-based codes, which divide services further into more specific codes for billing. Time-based units for billing should be used for what is classified as “constant attendance procedures.”
One example of this might be starting with an initial exam that takes 20 minutes and includes a review of the patient’s medical history and symptoms. The next part of the visit might be spent testing the range of motion, which could take another 15 minutes. After that, the therapist might spend 10 minutes providing manual therapy techniques.
The total time spent was 45 minutes which is technically 3 billable units. In this case, if you were not present for the entire exam because your team was paged for another patient, you could not bill for the entire 45 minutes. You would need to use the 8-minute rule and only bill for 36 minutes, meaning you can bill for two units instead.
Will the 8-minute Medicare rule apply to all insurance policies?
The 8-minute Medicare rule will apply to Medicare, TRICARE, Medicaid, and CHAMPUS. While private insurers may choose to adopt the 8-minute rule, they are not required to do so. Depending on any private plan you have enrolled in, like Medicare beneficiaries who also have private Medicare plans (Advantage and more), your plan may have different billing standards that will be followed. To find a plan that fits your needs you can visit an online Plan Finder.
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How does the 8-minute Medicare rule change my care?
The physical therapy process is largely the same, but there may be some changes in documentation and time management. You can still provide the same high-quality care to your patients, but you will need to document your services more accurately.
Exams, evaluations, and re-evaluations should be timed so that you can document the exact amount of time spent providing care. If you are providing manual therapy techniques, be sure to document the type of technique used and the amount of time spent performing it.
If you have multiple staff working on one patient, doctors should be tracking their time as well. In this way, the 8-minute rule can be applied to all Medicare Part B services.
What patients should be watching
The first thing patients should be watching is the time. If you’re receiving physical therapy services and feel like the therapist is rushing through your session, be sure to ask how much time is left. You have the right to receive care for the full duration of your appointment.
It can be difficult to keep track of time while you’re receiving care, so it’s important to be aware of the 8-minute rule and how it may affect your care.
If you have any questions about the 8-minute rule or how it may apply to your physical therapy services, be sure to consult an expert. They will have the most up-to-date information on the 8-minute rule and how it applies to your policy.
Hella Staff•February 3, 2022
