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. 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” can be used to standardize billing units, which are typically based on 15-minute increments spent with a patient. You must pay at least eight minutes of treatment for a 15-minute step. 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 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.
Your billing department would send Medicare an invoice for five billing units for Mr. Jones. The 15 minutes of ESUN support one additional service-based billing unit for a total of five units for that service date. 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 and the 8-minute rule are two calculation methods for determining the number of units allowed for timed codes. If you are treating a Medicare patient, you must charge according to the Medicare 8-minute rule.
The rule is applied automatically and cannot be modified. The Rule of 8 is a term for the rule published and described in the CPT Code Manual. This is an optional parameter that can be applied to non-Medicare types of insurance. But remember: these rules are only applied to direct timeout codes. Unattended electrical stimulation = 25 minutes = 1 billing unit CPT guidelines indicate that each timed code must represent 15 minutes of the treatment performed. However, not all treatments are carefully divided into 15-minute pieces for you. In these cases, the 8-minute rule is applied. According to Medicaid rules, a therapist who charges a time-based CPT code unit, which is typically 15 minutes, must offer at least 8 minutes of continuous therapy. Individually, you will only charge one unit for each of these units because you have not exceeded the eight-minute threshold to move to the next billing unit. However, you have two “remaining” minutes of physical exercise and six “remaining” minutes of manual therapy. Together, you have eight minutes, which would push you to the next billing unit.
Considering that it took us over 1,000 words to explain this billing process, it can be quite easy to run it incorrectly. We strongly recommend that you DO NOT try to do the math for each patient yourself. It is important to note that the rule of 8 only applies to relevant timed codes that have 15 minutes as the usual time in the operational definition of the code. In addition, clinicians should only apply this rule if your payer contract supports the rule. 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. The general concept is the same: billing is done in 15-minute increments, counting more than eight minutes of service for a 15-minute increment. However, time is not combined. Each 15-minute performance step is treated as if billed separately.
There are no mixed leftovers. Time-based (or constant presence) codes, on the other hand, allow variable billing in 15-minute increments. You would use this code to run standalone services, for example: B: Timecodes are defined in the AMA CPT codebook as services that are managed one by one in blocks of 15 minutes of time, for example 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. 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. How do you charge if you have enough minutes in total for 3 units, but you don`t have at least 8 minutes left after loading the full 15-minute sessions? Billing programs (like WebPT, which we`ve cited a few times in this article) offer calculators that do all of this for you. As long as you have the patient`s insurance information correctly and you have someone to properly enter all your electronic health records, you can`t mess up the eight-minute rule. These two rules are important for all physiotherapists. Agile EMR makes logging all documentation around these rules as efficient as possible. Our team strives to reduce wasted time and alleviate frustration at the clinic.
Schedule a demo today to enhance your EMR experience! Each timed code must represent 15 minutes of processing. Since not all treatments can be perfectly divided into 15-minute steps, there is the 8-minute rule to determine how many units you need to load in these cases. 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.) If you divide the total number of timed minutes by 15, you often get a balance that includes minutes of more than one service. For example, you might have five minutes left of therapeutic exercise and three minutes of manual therapy. Individually, none of these remains reach the 8-minute threshold. In combination, however, they amount to eight minutes — and according to Medicare`s billing guidelines, that means you can charge for one unit of service with the greatest total time (which would be a therapeutic exercise in this case). 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. Taking all this into account, let`s see how to correctly apply the 8-minute rule. First, you need to summarize all the time you`ve spent on timed procedures and modalities (such as ultrasound or supervised E-Stim). This should exclude any time spent on untimed codes such as many modalities or evaluations/re-evaluations. Use the following table (from www.ngsmedicare.com) to determine the total number of scheduled encoding units that you can charge. Mixed leftovers are delicate. If you divide the total number of timed minutes by 15 and get a balance that contains the remaining minutes of more than one service (code), these are mixed leftovers. If the sum of these leftovers is 8 (or more), you can charge an additional service unit (code) with the most time. (The 8-minute rule diagram above takes into account leftovers already mixed.) The 8-minute rule states that to receive Medicare reimbursement, you must provide treatment for at least eight minutes. If only one service is provided in a day, you should not charge for the services provided for less than 8 minutes.
However, if you charge more than one timed CPT code on a calendar day, the total number of units you can charge is limited by the total processing time. The rule of 8 follows the same principles as the rule of 8 minutes, but is calculated by service. In other words, a clinician must complete half of the service time described in a timed code before they can charge a unit of that code. Medicare`s 8-minute rule allows a clinician to charge Medicare insurance companies for a full unit if the service you offer takes between 8 and 22 minutes. Because of this provision, it can only apply to temporal CPT codes.