Therapists offering rehabilitation services to Medicare beneficiaries must adhere to the 8-Minute Rule as required by the Centers for Medicare and Medicaid Services (CMS). Unfortunately, in what has proved a very misleading term, the 8 Minute rule often confuses because many think it defines the timed code to bill one unit for the reimbursement of the various rehabilitation and therapies offered.
Understanding the complex 8 Minute Rule will help you prevent common mistakes and misunderstandings around any outpatient rehabilitation required.
Explaining the 8-Minute Rule
When patients receive services that require outpatient one-on-one care, these practitioners bill Medicare for the services received. The billing charges and claims use time-based codes known as the Medicare 8-Minute Rule that became effective on April 1, 2000.
Therefore, based on the rule, providers bill Medicare for one “unit” of their timed service when it lasts for at least eight minutes but less than 22 minutes. The purpose is to make it easier to determine how many units of 15-minute services the facility provides. The 8-Minute Rule specifies the units a practitioner can bill for services delivered at facilities providing rehabilitation, skilled nursing, therapies covered by Medicare Part B, outpatient departments, and some private practices.
How Does Billing Work with the 8-Minute Rule?
A health provider can only bill Medicare under the 8-Minute Rule when they have direct contact with the patient for 8 minutes or more when providing a service. Therefore, Medicare does not get billed if your therapy takes less than 8 minutes.
Anything between 8 and 22 minutes gets billed as a 15-minute service. The provider bills Medicare for two units if the service takes between 23 and 37 minutes. After that, the plan continues for another six 15-minute units that go up to just beyond two hours of service.
Therefore, if you need to visit a physical therapist at a private practice where he spends 15 minutes on an assessment, seven minutes answering your questions, and then performs 23 minutes of therapy, Medicare gets billed with 3 units of service.
Which Outpatient Providers Follow the 8-Minute Rule?
The outpatient and in-person services of the following providers follow the 8-Minute Rule:
- Rehabilitation facilities
- Skilled nursing facilities
- Home health agencies that provide Part B-covered therapies at the home of the beneficiary
- Outpatient and emergency hospital outpatient departments
- Private practices
Can Providers Use Another Billing Method?
No, providers cannot use another billing method for Medicare patients. However, the 8-Minute Rule also applies to other federally funded plans like Medicaid, TRICARE, and CHAMPUS. In addition, some commercial programs also cover it.
Does the 8-Minute Rule Change Patient Care?
No, the 8 Minute Rule does not change the process provided by the therapist. However, it does change the way they handle documentation and time management. Therapists provide the same high-quality care to patients. Still, they need to ensure that they document the services accurately for examinations, evaluations, and reevaluations, including time spent and types of techniques.
Even when several people work on one patient, careful time tracking ensures that even patients under Medicare Part B benefit from the 8-Minute Rule. Therefore, the rule helps make billing easier for therapists while ensuring patients receive the best care.
How Can You Ensure You Receive the Best Care under the 8-Minute Rule?
All patients have a right to care for the entire appointment, so keep an eye on the time, especially if you feel the therapist is rushing. However, physical therapy practices like physical, occupational, speech therapists, and professional nursing practices have high operating costs, making correct billing necessary. The 8 Minute Rule makes for a more straightforward billing management process.
Providers must know how to bill for their full range of services to avoid underbilling and for patients to understand what they can be charged for to prevent overbilling.
Awareness of the 8-Minute Rule and how it affects you ensures you receive the best care. Remember that if the treatment is under eight minutes, they cannot bill Medicare for that time.
Getting Help About the 8-Minute Rule
At The Modern Medicare Agency, we care that you understand the 8-Minute Rule and how it applies to your Medicare billing for direct contact physical and other outpatient services. Contact us to answer your questions and help you find coverage for gaps in your Medicare.