Medicare 8-Minute Rule: So Simple Yet Diabolically Complicated
Today's post comes from Tom Ambury, PT and compliance officer at PT Compliance Group. Thanks, Tom!
“Tom, how can you make a statement that the Medicare 8-minute rule is simple yet diabolically complicated?” I can make that statement because even though this rule has been in effect for years—and thus, people should have the hang of it—mistakes still happen. And when I talk to therapists about it, a lot of confusion still exists.
The 8-minute rule is how we determine what to bill to Medicare. To correctly calculate the charge, you must divide charges into two categories: time based (or “constant attendance”) modalities and procedures as well as supervised modalities and procedures. Constant attendance modalities and procedures include therapeutic exercise, manual therapy, neuromuscular reeducation, therapeutic activities, gait training, ultrasound, iontophoresis, and electrical stimulation attended. Supervised procedures and modalities would include physical therapy evaluation, physical therapy reevaluation, electrical stimulation unattended, and whirlpool.
What the 8-minute rule says—and how it got its name—is if you are performing only one constant attendance modality or procedure, you have to perform that modality or procedure for at least eight (8) minutes in order to bill that charge.
For example, I see a patient for the initial visit, and I perform my initial evaluation for 35 minutes with seven (7) minutes of therapeutic exercise. My charges are one unit of physical therapy evaluation. I cannot bill for therapeutic exercise because I performed that procedure for seven (7) minutes. So, by rule, I would need to perform therapeutic exercise for eight (8) minutes in order to bill it. Most therapists understand this, and your documentation system should prevent this type of error.
Where the diabolically complicated part comes in is when the therapist performs multiple constant attendance procedures or modalities and then must correctly calculate the charge. Complications arise because there’s a cumulative and distribution part of the rule.
When calculating the correct charges for multiple procedures and modalities, you must add the total constant attendance modalities and procedures together to get the “Direct Timed Minutes.” This number determines how many constant attendance units you can charge. At this point, you would determine how many supervised units to charge and determine the “Total Treatment Time.” To add to the diabolically complicatedness, there is also a rule to determine the correct distribution of charges. Let’s go through some examples:
On a date of service, you perform 30 minutes of therapeutic exercise (EX), 15 minutes manual therapy (MT), 8 minutes ultrasound (US), and 15 minutes of electrical stimulation unattended (ESUN). To correctly calculate the charge, add the constant attendance procedures and modalities:
30 min + 15 min + 8 min = 53 min of Direct Minutes, which supports four units of charge. The 15 minutes of ESUN supports an additional supervised unit charge for a total of five units billed.
Now the distribution: How many full 15-minute units did the therapist perform? In this example, there are two full 15-minute units of MT and one full 15-minute unit of EX. So, that‘s three units out of four. The ultrasound performed for 8 minutes is the remaining charge, so the correct bill would be two units of EX, one unit of MT, one unit of US, and one unit of ESUN.
Ok, that example was pretty straight forward; now let’s get more diabolical.
In this example, there are 30 minutes of EX, 25 minutes of neuromuscular (NM), 17 minutes of MT, 13 min of therapeutic activity (TA), eight (8) minutes of US, and 15 minutes of ESUN. Let’s calculate the charge:
30 min + 25 min + 17 min + 13 min = 93 min of Direct Minutes, which supports 6 units of charge. The 15 minutes of ESUN supports an additional supervised unit charge for a total of seven units billed.
Now the distribution: How many full 15-minute units did the therapist perform? There are two units of EX, one unit of NM with ten minutes left over, and one unit of MT with two minutes left over, all of which support four units of charge. The next step is to compare the minutes left over of the procedures performed: 13 minutes of TA, ten (10) minutes of NM, eight (8) minutes of US, and two (2) minutes of MT.
We have justified four units of charge, and because of the time, we are justified in charging two more units, but which two? To make this decision, we compare the time left over from the incomplete units and then bill the two larger of the units left over. So, in this example, we would add a unit of TA (13 minutes) and NM (ten minutes). We are not justified in billing US or an additional unit of MT.
So the correct billing in this example is two units of EX, two units of NM, one unit of MT, one unit of TA, and one unit of ESUN.
The key to the 8-minute rule is to do the math. Calculate the total units justified by time. Calculate the full 15-minute units. If time justifies additional units, compare the minutes of the partial units remaining and bill the larger of the minutes remaining.
Even though your documentation system will provide lots of assistance with the 8-minute rule, it’s a good idea to check your work; make sure your system is correctly calculating the charges using the Medicare 8-minute rule. After all, the 8-minute rule is ultimately your responsibility as the therapist.
Thank you for the opportunity to present this topic to you. If you have any questions, please post them in the comments section below or shoot me an email (email@example.com).