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The “8-minute rule” is a critical concept that healthcare providers, particularly physical therapists, need to understand for effective billing practices. This rule, primarily associated with Medicare, dictates that a provider must provide treatment for at least 8 minutes to bill for a service.
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What Does the 8 Minute Rule Mean?
The 8-minute rule helps providers measure time for billing purposes. It’s not just about how much money they can earn, but it also ensures the patient receives the best care. Medicare’s 8 minute rule applies to time-based Current Procedural Terminology (CPT) codes used by various outpatient providers.
Payers use these codes to identify different procedures and services. The rule uses a 15-minute increment as a segment for billable units. For instance, if a provider performs services between 8 to 22 minutes, Medicare can be billed for one unit, 23 to 37 minutes for two units, 38 to 52 minutes for three units, and so forth.
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How Does the 8-Minute Rule Work?
When a patient visits their outpatient healthcare provider, they present their Medicare card. The provider, knowing they’ll bill Medicare Part B for the visit, fills out the claim using specific CPT codes that apply to each service.
In the context of the 8 minute rule, physicians must provide treatment for at least 8 minutes to be reimbursed for the claim. Time-based units are divided into increments of 15 minutes, with different CPT codes for each time-based unit.
What Is the Difference Between Time-Based Units and Service-Based Units?
| Time-Based Units It allows you to bill multiple units with 15 minutes increments. | Service-Based Units You cannot bill more than one unit for this type of service, regardless of the time providers spent delivering treatment to the patient. |
It is the most common question what insurance or payer follows the 8-minute rule in outpatient therapy?
Medicare insurance follows the 8 minute rule for outpatient therapy. The outpatient therapy services are provided to Medicare beneficiaries in the following rules.
- Private practice.
- Skilled Nursing Facilities.
- Rehabilitation agencies.
- Home health centers providing part B therapy.
- Hospital outpatient departments.
The 8-minute rule also applies to insurance along with Medicare Part B. The payers who billed according to the 8-minute rule are as follows:
- Medicaid.
- Other federal insurance.
- Tricare (Services for Armed forces).
- BCBS for federal employees.
- Champus (veteran).
- Worker’s Compensation.
- Medicare Advantage programs.
- BCBS (Medicare advantage program)
- Aetna (Medicare advantage program)
- UHC (Medicare advantage program)
- Humana (Medicare advantage program)
- Wellcare (Medicare advantage program)
- Bill according to the 8-minute rule, if any federal payer.
- Any payer that follows the Medicare guidelines will use the Medicare 8-minute rule, it will also apply to private insurance.
What CPT codes are used in time-based units?
Time-based CPT codes allow you to bill in units with 15-minute increments. Providers use these codes for providing one-on-one services such as
- Manual Therapy (97140).
- Therapeutic exercise (97110).
- Therapeutic activities (97530).
- Neuro-muscular re-education (97112).
- Electrical stimulation manual (97032).
- Iontophoresis (97033).
- Ultrasound (97035).
- Gait training (97116).
Medical Billing Outsourcing for Physical Therapy?
Physical therapy is an intense specialty that requires a significant focus on patient care. Often, providers may not have enough time to concentrate on medical billing and coding.
Like other specialties, medical billing and coding are crucial for the financial success of physical therapy services. Outsourcing medical billing can help increase the revenue of their practice, reduce billing errors, and stay up-to-date with the requirements and regulations to ensure the correct submission of claims.
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There are many benefits of medical billing outsourcing. Some of them are as follows.
- Medical billing outsourcing allows providers to more focus on patient care.
- The main purpose of medical billing company is to provide billing services. They are responsible for ensuring that your claims are correctly submitted to the correct payer on time. Their billing reduces the billing errors in the medical billing process.
- A billing company charges a flat charge or percentage of reimbursement on each claim. It is less costly than the cost of medical billing staff, computer equipment, office space, furniture, etc.
- One reason that makes medical billing difficult is keeping up with the changes in Medicare, Medicaid, and other payers. Medical billing follows the proper protocol required by each payer, it is a full-time job. Medical billing companies stay up-to-date about the requirements and regulations to ensure the correct submission of claims.
- A medical billing company helps your practice improve cash flow. Cash flow is important for the success of your medical office. It reduces your burden and helps you to focus on the growth of your business. It boosts your productivity.
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