Billing Units 8 Minute Rule
The timed codes that physiotherapists use are, by definition, 15 minutes, which means that at least 8 minutes of a single service must be completed to charge for one unit of that service. The 8-minute rule has enough tricky scenarios to stumble upon even the weirdest mathematical genius. So, if you want to ensure accurate billing calculations, leave the long division to an EMR with built-in 8-minute control functionality. WebPT automatically reviews your work for you, notifies you when something doesn`t add up properly, and tells you if you`ve charged too much or too little. The 8-minute rule does not apply to all payers. Although some private insurance companies have adopted the 8-minute rule, not all have done so. For payers who do not follow Medicaid guidelines, you must ensure that you bill in accordance with your agreement with that payer. For example, if you have completed 17 minutes of treatment, Medicare will be charged 15 minutes or one unit. However, if you have completed a 23-minute treatment, Medicare will be charged for two treatment units. The bill would still apply to two units, whether you spent 23 or 30 minutes with the patient. As you`ve probably guessed, these codes are used to indicate how much time the patient spends in individual procedures with the therapist.
These include all forms of constant attendance procedures, such as physiotherapeutic exercises. Unlike service-based CPT codes, time-based CPT codes can be billed as multiple units in 15-minute increments. This means that one unit would represent 15 minutes of therapy. Suppose a therapist charges 10 minutes 97110 and 10 minutes 98116 in a single visit. These codes are considered unique services and are counted separately. Each service lasted more than eight minutes, so the therapist can charge a total of two units: one unit of 97110 and one unit of 98116. According to the graph, you can charge 3 units again depending on the total time. Your bill should include 2 units of therapeutic exercise, which is equivalent to 30 minutes with 2 minutes remaining. You don`t meet the 8-minute requirement for manual therapy just because of the 7 minutes, but since that`s more than the remaining 2 minutes of therapeutic exercises, add those minutes to the 7 minutes and can now charge 1 unit of manual therapy.
The 8-minute rule is not something to be afraid of. With a clear understanding of what the rule means, you can make sure you`re not being charged too much or too little. You deserve to be paid for the services you provide in accordance with the Medicare rule. MWTherapy can help you comply with Medicare and provide you with built-in tools to help you stay on track. The 8-minute rule states that to receive Medicare reimbursement, you must provide treatment for at least eight minutes. Next, you need to determine which codes should assign the correct number of units accordingly. This should be done based on the number of minutes each service has been deployed, although there are some caveats. First, you need to charge 1 unit for each service provided for at least 15 minutes. Sometimes it`s simple: if you offer 15 minutes of therapeutic exercises, calculate 1 unit of this code, 30 minutes of neuromuscular rehabilitation is 2 units of this code. But let`s look at some examples of how you charge if you don`t spread the total time evenly over 15-minute steps, which is most typical: Medicare has certain rules and regulations to prevent fraud, waste, and abuse.
Here`s one you may have never heard of: the 8-minute rule. Providers must treat patients for at least eight minutes to receive Medicare reimbursement. Since the total time is only in the range of 1 unit, that`s all you can charge. The procedure with the most minutes are therapeutic activities to load 1 unit of this code and include the other minutes in this billing. Once the stimulation is complete, guide Mr. Jones through 20 minutes of manual therapy and 20 minutes of therapeutic exercise. Timecodes are defined in the AMA CPT codebook as services managed one by one in 15-minute time blocks, such as 1 unit = 15 minutes. This is where the 8-minute rule comes into play to determine the number of units that can be charged for this tour.
Do you know the 8-minute rule? Click here to learn more. Mixed activities cannot be grouped together. This means that if you do physiotherapy with a patient for only five minutes, your timer will be reset before starting the next activity. You can`t charge Medicare until you`ve worked with a patient on an activity for at least eight minutes. Okay, that was a confusing lesson when it came to billing! Let`s go through an example and gather everything we`ve learned. This is where the eight-minute rule comes into play. You only need to spend eight minutes with a patient to be able to charge a unit of “15 minutes”. However, if you spend 16 minutes with a patient, you can still only charge one unit.
It would take 23 minutes (15 + 8) with a patient to fall into the two-unit range. 7 minutes of manual therapy + 8 minutes of therapeutic activities + 7 minutes of self-care patient training / home management training = 21 minutes If you create documentation in front of the patient (for this patient) during your intervention work with him, you can include it in your protocols. However, you should not specify the time of documentation that was performed outside the patient. CMS generally indicates that the time spent writing notes outside the patient is not billable. You can find the “Rule of Eight”, sometimes referred to as the 8-minute ama rule, in the CPT code manual. This CPT rule is slightly different from the CMS rule for Medicare and Medicaid. In 2018, the amount Medicare can pay for a massage therapy unit is nearly $3 more than a manual therapy unit. However, as a general rule, you should only charge for CPT codes that accurately describe the treatment offered. You should never charge for a code just because it results in a higher payment. It is a foolproof way to land in hot water. When therapists provide Medicaid with an invoice for the services provided, CPT codes are used to indicate the services the patient has received.
A service-based CPT code is one that indicates that services such as physiotherapy examinations or simple outpatient procedures and treatments have been provided. These services cannot be charged for more than one unit, regardless of the time required. The 8-minute rule only applies to time-based CPT codes for manual and physical therapy. This falls under Part B of Medicare for Ambulatory Therapy. When billing for rehabilitation services provided to Medicare recipients, the Centers for Medicare and Medicaid Services (CMS) requires therapists to adhere to the so-called “8-minute rule.” This term is a bit misleading because it seems to imply that if you run at least 8 minutes of a procedure set as a timed code, you can charge 1 unit for it. Unfortunately, as is often the case with CMS, it`s not that easy. The use of the formula total time / 15 = units and the subsequent calculation of residues allow a more precise allocation of this additional unit. For time-based codes, you must undergo direct processing for at least eight minutes to receive a Medicare refund.
Basically, when calculating the number of billable units for a given service date, Medicare adds up the total number of minutes of qualified individual therapy and divides that sum by 15. If there are eight minutes or more left, you can charge another unit. If there are seven minutes or less left, you cannot charge for an additional unit. Technically, you just spent 45 minutes with the patient, which would equate to three billing units. However, those first 25 minutes only counted as one unit, because you weren`t in the room all the time and weren`t performing an undivided task. Therefore, you can only charge for two units. As you may know, CPT codes are medical codes that describe the procedures and services you perform for billing agencies and insurance companies. They were launched in 1966 by the American Medical Association to simplify and standardize procedural reporting. The physiotherapy billing guidelines for Medicare and Medicaid services include a section on how much time you need to spend with a patient in order for them to be “billable.” Billing with Medicare physiotherapy is done in increments of 15. So, what should you do if your treatment only lasts 13 minutes? Billing based on CPT services is different from time-based CPT coding guidelines. The rule of eight, which is found in the CPT code manual and sometimes referred to as WADA`s 8-minute rule, is a minor variant of the CMS`s 8-minute rule.
The rule of eight still counts billable units in 15-minute increments, but instead of combining the time of multiple units, the rule is applied separately to each individual timed service. Therefore, mathematics is also applied separately. (Note that the rule of eight only applies to scheduled codes where 15 minutes are listed as “usual time” in the code`s operational definition.) Unattended electrical stimulation = 25 minutes = 1 billing unit Yes, but only if you perform additional procedures that day. The initial eval code is unplanned code. Regardless of its length or complexity, there is no temporal definition for the initial assessment. If you perform additional procedures on that day, such as: Initiate manual therapies or therapeutic exercises, you would summarize the minutes spent on these time codes and charge for the appropriate units as described above. Let`s say your treatment consisted of 25 minutes of therapeutic exercise, 20 minutes of cervical mechanical traction and 13 minutes of therapeutic activities. They add the minutes of therapeutic exercise and the minutes of therapeutic activity, which is equivalent to 38 minutes. You would charge 2 units of therapeutic exercises and 1 unit of therapeutic activities for timed codes.
However, since cervical mechanical traction is an untimed code, calculate 1 unit.
