All physical therapy practices need to deal with billing with insurance companies. That’s just a part of running one. However, not all physical therapy practices work directly with Medicaid, but they may have an opportunity to do so. If your physical therapy practice is looking to get involved with patients who take Medicare, then it is extremely important that you understand just how physical therapy billing with Medicare works. Simply put, the system that is in place is called the Medicare 8 minute rule. Within that system, physical therapists need to bill using what is called billing units. With that in mind, here is how Medicare determines what a billing unit is, and how you can correctly use the system in place to treat your patients as efficiently as possible.
The Medicare 8 Minute Rule Explained
To determine patient billing, Medicare uses a simple system for physical therapists. They break this down int billing units, which are defined very narrowly. The system in place was created by the Medicare Administrative Contractor National Government Services, and is determined by Local Coverage Determination (LCD). In simple terms, the LCD uses time codes to explain what a billing unit is. These billing units need to be billed only for time when a physical therapist is directly attending to a patient, not for when they are waiting for machines, appointment scheduling, or working with physical therapy assistants.
That being said, the time codes for the Medicare 8 minute rule are quite strict. For one, as the namesake of the rule suggests, you need to do at least 8 minutes of dedicated care in order to bill for a unit. However, that unit can extend to anywhere from 8 minutes to 22 minutes. However, if you combine two different tasks, you can roll them over into that unit in order to make up the time. Every subsequent unit is billed in 15 minute increments, so you will need to make sure that all care that you perform on a patient is done within this time frame in order to get properly compensated for your work.
While this may seem daunting at first, working with Medicare can give you an incredible number of recurring patients, all who need chronic care due to their advanced age. However, in order to do so, you need to know how to directly apply the Medicare 8 minute rule for billing purposes. If you do not follow this rule, or if you try to bill incorrectly, you may have issues getting reimbursed by Medicare, or may be flagged as someone who cannot work with Medicare. As such, it is important that you know how the process works, and what you can do to make sure that you can get properly compensated for the work that you perform. Overall though, working with Medicare is very advantageous to physical therapy practices, even if the Medicare rule of 8 billing system is a bit complex.