Many physical therapy practices that deal with an older patient population often find that they are also dealing with Medicare as their primary insurer. As such, it is important that physical therapy practices who deal with geriatric care have a strong understanding of how Medicare sets its billing rules and regulations. The primary way that Medicare works in terms of medical reimbursement is through the Medicare 8 minute rule. In essence, this is a system that Medicare has devised in order to ensure that the government is not being overbilled for physical therapy services through Medicare. To do so, they have come up with a systematic method of medical billing through the use of billing units. With that in mind, here is how to make sure that you are billing Medicare properly for your physical therapy services.
Learning About Medicare Billing Units
Unlike other insurances, Medicare is stricter because it is paid for by the American taxpayer. As such, they have an extremely precise system laid out so that physical therapists can correctly bill for their services, and also not overbill the government. The Medicare 8 minute rule factors into this by being the minimum amount of time that a physical therapists needs to spend with a patient on a one-on-one basis (be aware that this cannot be time the patient spends with a physical therapy assistant or other support staff) in order to bill for their services. For the first medical billing unit, a specific physical therapy service needs to be performed within an 8 to 22 minute window. Subsequent units are then billed in 15 minute increments Any less cannot be billed for as a sperate entity, and most be rolled into a service that was performed for that time period. So, for example, if you are treating a patient on a specific machine or part of their body for only 5 minutes, and on another machine or part of their body for 14 minutes, you can roll those two services into one billing unit.
However, where you can make this more advantageous toward your physical therapy practice is if you perform the lesser service for 7 minutes, and the major service for 20 minutes. This will put you well within the range of two medical billing units, and will allow you to bill as such. However, do keep in mind that you don’t want to game the system and provoke an audit. These are hard to recover from and can result in your physical therapy practice being tied up in legal issues that will ultimately impact your patient’s care.
That being said, the Medicare rule of 8 should always be strictly abided by when dealing with Medicaid. Because Medicare is government run, you should expect it to follow all the rules and regulations to the letter. If you do so, you’ll find that the 8 minute rule is fair to both Medicare and to the physical therapists, and can help physical therapy practices better regulate patient care and make sure that each patient gets precisely the amount of care they need.