Guest guest Posted August 18, 2010 Report Share Posted August 18, 2010 Hello Group, Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! Balan Solex Physical Therapy Naples, FL abalan@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2010 Report Share Posted August 18, 2010 The 8 minute rule applies only to Medicare unless other payers also say they follow Medicare's 8 minute rule. To assume otherwise could be costing you money. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@... > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2010 Report Share Posted August 18, 2010 , The 8 minute rule started with Medicare (as far as I know). Some payors will follow this rule and others may not. The CPT Assistant (December 2003) published by the American Medical Association (AMA) states " As with any 15-minute timed code, it is important to recognize that a SUBSTANTIAL PORTION OF THE 15 MINUTES must be spent in performing the pre-, intra-, and post service work… " . This applies to all time based codes. The AMA also states specific payers may have their own rules regarding substantial amount of time to bill a unit of a timed based CPT code This can be found in the February 2004 edition of CPT Assistant. Jon Mark Pleasant, PT Methodist Medical Center > > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@... > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2010 Report Share Posted August 18, 2010 No, unless your state w/comp dictates it. Sue Whitney PT ________________________________ To: PTManager Sent: Wed, August 18, 2010 8:50:54 AM Subject: 8 minute rule Hello Group, Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! Balan Solex Physical Therapy Naples, FL abalan@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2010 Report Share Posted August 19, 2010 Does anyone have any good arguments/suggestions for implementing this in a hospital system? We have a very obstinate director of billing who thinks it is fraud to have two different ways of billing. He also sites that none of the area hospitals do anything but 8-minute rule. The financial argument and legality of following the AMA CPT or per contract methodology is just not cutting it with him. Thoughts appreciated. Meryl Freeman, MS PT Manager, Outpatient Rehab Rex Healthcare Re: 8 minute rule The 8 minute rule applies only to Medicare unless other payers also say they follow Medicare's 8 minute rule. To assume otherwise could be costing you money. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com On Aug 18, 2010, at 6:50 AM, " abpt25 " <abpt25@... <mailto:abpt25%40aol.com> > wrote: > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@... <mailto:abalan%40solexcenters.com> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2010 Report Share Posted August 19, 2010 Meryl- We too are a hospital based practice with both inpatient rehab and OP services and have always applied the 8 minute rule to all billing, regardless of payer. The comment was, as you said, that to have two charging systems and charge Medicare patients differently from other patients is fraudulent. Recently we have been asked to reassess that practice and consider using the " substantial portion " methodology specifically for those payers who do not follow the 8 minute rule. A concern I have is how to help the therapists (over 75 in my facilities alone) all know which payer " follows Medicare Guidelines " and which do not. A considerable number do " follow Medicare Guidelines. There is the risk of using the wrong charging concepts and setting yourself up for a charge of fraud. The next question I have is directed to those of you who use software, EMR, or an office manager to interpret documentation and drop specific charges ( and not have the therapists do that themselves as we do). Our therapists document and indicate the units of specific CPTs to be billed for the patient for that treatment. They even indicate modifiers as appropriate So in the setting with a third party/computer doing it- Who is responsible if there is an error? ( I.E- who gets to wear the orange jump suit?). I frankly am reluctant to have a non clinician use my billing number (if I were in private practice- hospital based OP does not use individual NPIs) drop units of CPTs that may or may not be correct. I do not feel I should abdicate that responsibility. I appreciate the conversation and input. Marcy Stalvey, PT,MS, NCS Therapy Supervisor Edwin Shaw Rehabilitation Institute Cuyahoga Falls, OH >>> " Freeman, Meryl " 8/19/2010 2:32 PM >>> Does anyone have any good arguments/suggestions for implementing this in a hospital system? We have a very obstinate director of billing who thinks it is fraud to have two different ways of billing. He also sites that none of the area hospitals do anything but 8-minute rule. The financial argument and legality of following the AMA CPT or per contract methodology is just not cutting it with him. Thoughts appreciated. Meryl Freeman, MS PT Manager, Outpatient Rehab Rex Healthcare Re: 8 minute rule The 8 minute rule applies only to Medicare unless other payers also say they follow Medicare's 8 minute rule. To assume otherwise could be costing you money. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com On Aug 18, 2010, at 6:50 AM, " abpt25 " <abpt25@... <mailto:abpt25%40aol.com> > wrote: > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@... <mailto:abalan%40solexcenters.com> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2010 Report Share Posted August 19, 2010 Hi, The most effective argument is to show how much money is being lost by these billing practices but that will take time and work. Take sample cases (maybe one day or one week's worth of billing) done using the eight minute rule and then compare using standard rules and show how much is being lost. If you handle work comp or third party cases, these would be the best to demonstrate the loss as these cases, depending upon which state you are in, are generally reimbursed better than Medicare or private insurance. This kind of review requires that you absolutely understand both set of rules, so make sure you are clear on the rules first. The main things you want to look for are cases with multiple procedures all taking a substantial part of a 15 minute unit but whose billing required dropping a procedure to satisfy the eight minute rule. Then take it to the billing director and see if he changes his mind. You could also compile the policies and procedures for billing or statements from insurers clarifying their billing practices and add that to your defense. Tom Howell, P.T., M.P.T. Howell Physical Therapy Eagle, ID thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. _____ From: PTManager [mailto:PTManager ] On Behalf Of Freeman, Meryl Sent: Thursday, August 19, 2010 12:33 PM To: PTManager Subject: RE: 8 minute rule Does anyone have any good arguments/suggestions for implementing this in a hospital system? We have a very obstinate director of billing who thinks it is fraud to have two different ways of billing. He also sites that none of the area hospitals do anything but 8-minute rule. The financial argument and legality of following the AMA CPT or per contract methodology is just not cutting it with him. Thoughts appreciated. Meryl Freeman, MS PT Manager, Outpatient Rehab Rex Healthcare Re: 8 minute rule The 8 minute rule applies only to Medicare unless other payers also say they follow Medicare's 8 minute rule. To assume otherwise could be costing you money. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com On Aug 18, 2010, at 6:50 AM, " abpt25 " <abpt25@... <mailto:abpt25%40aol.com> <mailto:abpt25%40aol.com> > wrote: > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@... <mailto:abalan%40solexcenters.com> <mailto:abalan%40solexcenters.com> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2010 Report Share Posted August 19, 2010 Meryl, I believe that is correct. What I have learned from being in an outpatient hospital setting for the past 11 years is that there cannot be any deviation from one patient to next (even with documentation), as this is a corporate compliance issue. In my department we follow the 8 minute rule regardless of the patient and or payer type. NY > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@... <mailto:abalan%40solexcenters.com> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2010 Report Share Posted August 20, 2010 Depends on what he means by " area hospitals " . I'm told that our colleagues in the WS area use a different billing scheme for commercially insured folks vs Medicare. From: PTManager [mailto:PTManager ] On Behalf Of Freeman, Meryl Sent: Thursday, August 19, 2010 2:33 PM To: PTManager Subject: RE: 8 minute rule Does anyone have any good arguments/suggestions for implementing this in a hospital system? We have a very obstinate director of billing who thinks it is fraud to have two different ways of billing. He also sites that none of the area hospitals do anything but 8-minute rule. The financial argument and legality of following the AMA CPT or per contract methodology is just not cutting it with him. Thoughts appreciated. Meryl Freeman, MS PT Manager, Outpatient Rehab Rex Healthcare Re: 8 minute rule The 8 minute rule applies only to Medicare unless other payers also say they follow Medicare's 8 minute rule. To assume otherwise could be costing you money. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com On Aug 18, 2010, at 6:50 AM, " abpt25 " <abpt25@...<mailto:abpt25%40aol.com> <mailto:abpt25%40aol.com> > wrote: > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@...<mailto:abalan%40solexcenters.com> <mailto:abalan%40solexcenters.com> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2010 Report Share Posted August 20, 2010 Skip: I have it on good authority that you are correct about our WS colleagues! Good point. Meryl Freeman, MS PT Meryl W. Freeman, MS PT Manager, Outpatient Rehab (919)784-4676 (office) (919)621-3787 (cell) ________________________________ From: PTManager <PTManager > To: PTManager <PTManager > Sent: Fri Aug 20 07:41:05 2010 Subject: RE: 8 minute rule Depends on what he means by " area hospitals " . I'm told that our colleagues in the WS area use a different billing scheme for commercially insured folks vs Medicare. From: PTManager <mailto:PTManager%40yahoogroups.com> [mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On Behalf Of Freeman, Meryl Sent: Thursday, August 19, 2010 2:33 PM To: PTManager <mailto:PTManager%40yahoogroups.com> Subject: RE: 8 minute rule Does anyone have any good arguments/suggestions for implementing this in a hospital system? We have a very obstinate director of billing who thinks it is fraud to have two different ways of billing. He also sites that none of the area hospitals do anything but 8-minute rule. The financial argument and legality of following the AMA CPT or per contract methodology is just not cutting it with him. Thoughts appreciated. Meryl Freeman, MS PT Manager, Outpatient Rehab Rex Healthcare Re: 8 minute rule The 8 minute rule applies only to Medicare unless other payers also say they follow Medicare's 8 minute rule. To assume otherwise could be costing you money. Rick Gawenda, PT President/CEO Gawenda Seminars http://www.gawendaseminars.com On Aug 18, 2010, at 6:50 AM, " abpt25 " <abpt25@... <mailto:abpt25%40aol.com> <mailto:abpt25%40aol.com> <mailto:abpt25%40aol.com> > wrote: > Hello Group, > > Does the 8 minute rule apply only to Medicare patients? Must we follow the 8 minute rule for workers comp and private insurance patients as well? Thanks! > > Balan > Solex Physical Therapy > Naples, FL > abalan@... <mailto:abalan%40solexcenters.com> <mailto:abalan%40solexcenters.com> <mailto:abalan%40solexcenters.com> > > Quote Link to comment Share on other sites More sharing options...
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