Understand Medicare’s “8-minute rule” and other terms as a Medicare beneficiary so you’ll know how Medicare charges for the services you receive. Some practitioners are not aware of this document properly, so errors can occur occasionally. Errors like these can lead to underbilling or delayed reimbursement.
Providers of physical therapy and other services to Medicare are billing Medicare for the services recipients receive. Billing and claims are processed through current procedure code (CPT) and rules. These rules are one of the ones that Medicare adheres to. It is imperative for beneficiaries to learn how the 8-minute rule works and why it is so important.
Medicare’s 8-Minute Rule: What is it?
In the case of outpatient services, such as physical therapy, Medicare gives a stipulation known as the 8-minute rule. The 8-minute rule came into effect on April 1, 2000, after it was introduced in December 1999.
The rule imposes a limit of eight (but no more than 22) minutes for a single unit of service. An invoice for a single service entails a specific period of time for the service. Each unit of service is 15 minutes long under the 8-minute rule.
The 8-Minute Rule for Medicare – How Does It Work?
The 8-minute rule does not apply to services carried out by practitioners who have direct contact with patients. Thus, the 8-minute rule applies only if the service is provided in person.
You’ll get reimbursed based on the total number of minutes spent per discipline if you’ve received multiple services. Medicare won’t be charged for individual services that take less than eight minutes.
A 15-minute interval is then billed for each service. Because the number of minutes falls between eight and 22 minutes, the Medicare bill will reflect one unit for a service that takes 20 minutes.
The Medicare beneficiary can be billed two units for the service(s) if there is a duration of between 23 and 37 minutes. After two hours, the practitioner charges for three units for 38 to 52 minutes, and this pattern continues (in fifteen-minute intervals) until the other end.
Remember:
Medigap Open Enrollment Periodstarts within the six-month period following your Part B effective date beginning on the first day of the following month.
How many people follow the 8-minute rule?
When billing Medicare for outpatient services, the following outpatient providers follow the 8-minute rule:
- Private practices
- Skilled nursing facilities
- Rehabilitation facilities
- Part B therapy provided in the home by home health agencies
- Emergency departments of hospitals (including outpatient departments)
- Usually, the 8-minute rule’s practitioners provide in-person and outpatient services.
When is the Rule Not Applicable?
Medicare does not apply only to this 8-minute rule. These provisions apply to federally funded plans as well as the following:
- Medicaid
- TRICARE
- The Canadians participate in a program known as CAMPUS.
Also, some commercials follow the eight-minute rule. CMS requires that the eight-minute rule be followed for individuals requiring these services in person, outpatient, so these providers cannot opt for another billing method.
Examples:
The physical therapist is located at the hospital where Lynne visits. 31 minutes of therapeutic exercise are given to her, along with 14 minutes of manual therapy. After that, she undergoes a nine-minute ultrasound that takes her upstairs. In total, Lynne will receive four units of service on her Medicare plan, since the number of minutes between the services is 54.
It is not billed separately for the ultrasound in the example above. In Medicare’s billing, the minutes taken for each service are combined and billed as a total number of units.
For another example, Gregory has a private practice with his physical therapist. Gregory’s physical therapist spends a total of 16 minutes assessing his condition, 23 minutes with manual therapy, and seven minutes answering his questions. Medicare will charge the office three unit charges for this visit, which consists of 46 minutes.
It is sometimes, however, unclear when providers are supposed to bill for assessments. Underbilling occurs as a result. The patient should therefore be aware of what Medicare can and should be charged for, since they are likely to be over-billed. This should be kept in mind by providers to ensure that they don’t underbill for services.
Comments are closed.