Best Practices for Properly Utilizing the 8-Minute Rule in Physical Therapy Billing

If you're new to the healthcare industry, the complexities of medical billing may be overwhelming. It's a struggle even if you've been here a while. There are numerous rules to follow to code for the services you provide to be reimbursed correctly. Here we can understand about best practices for Properly Utilizing the 8-Minute Rule in Physical Therapy Billing.

You must ensure you do it correctly the first time to avoid claim denials. After all, you won't get paid until the insurance company accepts your claim and reimburses you. To avoid typical insurance denials, you must optimize your bill submission process.

But matters are further complicated as there are two distinct CPT coding methods for practitioners with direct contact with patients, notably physical therapists. Each CPT code is billed in either service-based or time-based units. Those that use time-based units necessitate more effort than just providing the length of the appointment. However, after you've understood the 8-minute rule, you can appropriately code with time-based units.

Let’s understand the concept of 8 Minute rule in physical therapy billing first:

Untimed Code

Un-timed codes, also known as service-based CPT codes, do not have a time limitation and are typically given to a patient only once per day. Regardless of how long these codes are performed on the patient, just one unit is billed.

Timed Code

The AMA CPT code book defines time-based codes as services provided one-on-one in 15-minute increments, e.g., 1 unit = 15 minutes. The 8-minute rule can be used to find out the number of units billed for that visit.

How to apply the 8-minute rule?

The most basic way to think about this is to sum up all the time spent providing these timed codes. You would bill 1 unit of that code every 15 minutes of one service. You may bill another unit if there are at least an additional 8 minutes remaining. If you have 7 minutes remaining, you cannot bill for it.  For example, you may bill three units if you provided 38 minutes of one-on-one treatment for timed codes. However, if you provide 37 minutes of care, you can only bill for two units.

Insurances Adhering to the 8-minute Rule

The 8-minute rule typically applies only to Medicare patients. Other third-party payers often adopt the midway rule, which states that you may bill one unit for any timed operation or modality that lasts 8 minutes or more. The complete time requirement is irrelevant here. As always, this depends on your payer contracts, so make sure you are up to date on those facts and any changes to these guidelines for these payers.

Best Practices for the 8-Minute Rule

• Include Other Time

It is important to note that CPT rules permit physicians to bill for the time spent maintaining, educating, and assessing a resident about their current condition as indicated by each code. Rehabilitation therapists, for example, may lose billable services if they fail to bill for these CPT codes and list the functions on the claim.

• Bill for Documentation Time

It is possible to bill for documentation done in the patient’s presence. If the documentation is completed later and not in the presence of the patient or resident, the service is not billable. So, if physical therapy addressed intervention outcomes with the patient and then proceeded to document during this visit while in the presence of the patient—without leaving to handle another patient—then this action is billable labor under Medicare CPT code standards.

• Combine Mixed Remainder

If a treatment or process is less than 8 minutes long, the remaining minutes left can still be billed by combining mixed remainders under the eight-minute rule.

For instance, Therapeutic exercise lasts 20 minutes, leaving five minutes (unbillable). And manual therapy lasts 18 minutes, leaving three minutes (unbillable). Take that 38-minute total and divide it by 15 to get two billable units and an 8-minute leftover. The 8 denotes an additional billable unit under the Medicare 8-minute rule. And that extra unit can be billed as a second unit of the more extended service (20-minute therapeutic exercise). As a result, we have three total billable units for these two services.

Conclusion

The 8-minute rule is nothing to be concerned about. You can avoid overbilling or underbilling with a clear understanding of the regulation. In accordance with Medicare's rules, you are entitled to payment for the services you provide. 24/7 Medical Billing Services can assist you with Medicare compliance by providing built-in solutions to keep you on track.

See also: CPT Codes For Physical Therapy Billing