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A Comprehensive Guide to the Medicare Rule of 8 for Physical Therapy Billing

As a physical therapy practice, working with Medicare can prove to be complex. This is because their billing structure is quite different than that of private insurance. For one, there are specific rules and regulations that need to be followed, as Medicare is government funded, and has more stringent government regulations surrounding it. As such, it is important to understand how to best be complaint with Medicare if you are intending on taking patients who have this insurance at your physical therapy practice. A great place to start here is with the Medicare rule of 8. Also known as the 8 minute rule, this rule regulates the amount of time that a physical therapist needs to treat a patient in order to bill for their services. With that in mind, here’s what you need to know in order to correctly follow the rules and regulations around the Medicare rule of 8.

Using Billing Units to Determine Payments with the Medicare Rule of 8

Like most insurance, Medicare uses a specific billing system to determine how physical therapists can correctly bill for their services within medical compliance. However, the Medicare rule of 8 specifically uses billing units to determine how you can bill for your services. This is done is a smooth and codified manner, and all billing most be in 15 minute increments. However, physical therapists need to be aware that what the 8 minute rule is really referring to is the minimum time that a physical therapist needs to directly be treating a patient (time with support staff or physical therapy assistants does not count toward these billing units) in order to bill for their services.

For the first billing unit, any time within 8 minutes to 22 minutes is considered to be one billing units. Every 15 minutes thereafter is considered a separate billing unit, although it cannot be less than 8 minutes over the initial amount. So, for example, 25 minutes of treatment on a specific machine or exercise would be considered one billing unit, while 30 minutes of direct specific treatment would be considered two billing units. This cannot, of course, include any idle time that the patient is spending, including dealing with medical billing or scheduling, or waiting for machines.

Because Medicare is so strict, not following this system and attempting to overbill will be tantamount to risking a potential audit. As such, you need to ensure that every unit you are billing for is focused on a specific type of therapy. Do keep in mind though that if you perform several different services and they don’t fit neatly into billing units (for example, you may spend 12 minutes on one machine and 7 minutes on another), you will need to roll the extra time into a specific physical therapy service in order to get reimbursed by Medicare. The general rule to follow here is to package the time into the service that you’ve performed the most during that particular physical therapy session in order to ensure that you are reimbursed by Medicare.

Once you understand this process, it should be quite a bit easier to correctly apply the Medicare of 8 to your physical therapy practice so that you do not run into any issues with rules and regulations. Doing so will ensure that you always get billed for the time that you spend with patients, and ensures that medical billing issues never get in the way of offering the best treatment and care possible to your patients.

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