reimbursements Archives | Page 3 of 13 | WebPT

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The 8-Minute Rule: What it is and How it Works in WebPT

With most buyer-seller transactions, calculating the cost of a product or service is fairly simple. There are no complicated formulas for determining the monetary value of a pizza or a movie ticket; you simply pay the business’s advertised price. When it comes to Medicare’s payment for rehab therapy services, however, things aren’t always so simple. Yes, I’m talking about the dreaded 8-Minute Rule (a.k.a. the Rule of Eights). So, here’s a rundown of the rule as well as how it works in WebPT—followed by a comprehensive FAQ.

The Basics

The 8-Minute Rule governs the process by which rehab therapists determine how many units they should bill to Medicare for the outpatient therapy services they provide on a particular date of service (extra emphasis on the word “Medicare” as this rule does not apply to other insurances unless they have specified that they follow Medicare billing guidelines). Basically, a therapist must provide direct, one-on-one therapy for at least eight minutes to receive reimbursement for a time-based treatment code. It might sound simple enough, but things get a little hairy when you bill both time-based and service-based codes for a single patient visit—and therein lies the key to correctly applying this rule.

Time-Based vs. Service-Based

So first, let’s talk about the difference between time-based and service-based CPT codes. You would use a service-based (or untimed) code to denote services such as conducting a physical therapy examination or re-examination, applying hot or cold packs, or providing electrical stimulation (unattended). For services like these, you can’t bill more than one unit—regardless of the amount of time you spend delivering treatment.

Time-based (or direct time) codes, on the other hand, allow you to bill multiple units in 15-minute increments (i.e., one unit = 15 minutes of direct therapy). These are the codes you use for one-on-one, constant attendance procedures and modalities such as therapeutic exercise or activities, manual therapy, neuromuscular re-education, gait training, ultrasound, iontophoresis, or electrical stimulation (attended).

Minutes and Units

According to CPT guidelines, each timed code represents 15 minutes of treatment. But your treatment time for these codes won’t always divide into perfect 15-minute blocks. What if you only provide ultrasound for 11 minutes? Or manual therapy for 6 minutes? That’s where the 8-Minute Rule comes in: Per Medicare rules, in order to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes. In other words, Medicare adds up the total minutes of skilled, one-on-one therapy (direct time) and divides the resulting sum by 15. If eight or more minutes are left over, you can bill for an additional unit. But if seven or fewer minutes remain, Medicare will not reimburse you for another full unit, and you must essentially drop the remainder. To give a simple example, if you performed manual therapy for 15 minutes and ultrasound for 8 minutes, you could bill two direct time units.

However, when untimed codes come into play, things get a little more confusing. So, to figure out how many total units you should bill, you should always start by calculating your total time (i.e., direct time + unattended time). Then, check your total against the chart below to see the maximum total number of codes you can bill:

8 – 22 minutes

1 unit

23 – 37 minutes

2 units

38 – 52 minutes

3 units

53 – 67 minutes

4 units

68 – 82 minutes

5 units

83 minutes

6 units

The key word here is “maximum.” There are times when you cannot bill the full number of units given in the chart. For example, let’s say that on a single date of service, you provide a patient with 30 minutes of therapeutic exercise, 15 minutes of manual therapy, 8 minutes of ultrasound, and 30 minutes of electrical stimulation (unattended). Per the 8-Minute Rule, you would first calculate the total treatment time: 30 min + 15 min + 8 min + 30 min = 83 total minutes

According to the chart, you could bill a maximum of 6 units. However, in this case, when adding up your direct time (time-based) codes, it equals 53 minutes. If you divide 53 by 15, you get 3 with a remainder of 8, which means you can bill 4 units of time-based codes. But because the untimed code accounts for the remaining 30 minutes of your total time—and you can only bill 1 unit for that an unattended modality regardless of how many minutes the patient spent receiving the service—you could not bill the full 6 units indicated in the chart above. Instead, you would bill 2 units of therapeutic exercise, 1 unit of manual therapy, 1 unit of ultrasound, and 1 unit of electrical stimulation (unattended), for a grand total of 5 units.

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Common Questions from Our PT Billing Open Forum

Last week, WebPT’s trio of billing experts—Dr. Heidi Jannenga, PT, DPT, ATC/L, WebPT President and Co-founder; John Wallace, PT, MS, WebPT Chief Business Development Officer of Revenue Cycle Management; and Dianne Jewell, PT, DPT, PhD, WebPT Director of Clinical Practice, Outcomes, and Education—hosted a live open forum on physical therapy billing.

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The True Cost of a Denied Claim in Your PT Practice

Claim denials are the worst. Not only does remedying them require additional time and resources, but they also delay cash flow—a situation that can be difficult for practices to navigate. While you may be tempted to overlook one or two denials, these pesky problems add up quickly—and even a couple can point to a much larger issue. And that issue that could cost your clinic a lot of money. Here’s what you need to know about the true cost of a denied claim—including some denied health insurance claims statistics:

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Legal Compliance: One More Reason to Collect Patient Deductibles and Copays

Colllecting coinsurance, copays, and deductibles upfront is an important piece of the effort to accurately value the services we provide. And yet, we still hear about practices that routinely waive their patients’ deductibles and copays. Today, I’ll discuss another reason not to routinely waive deductibles and copays.

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