Medicare is a complicated program, and unless you are familiar with it, it can be hard to understand how it works. The 8-minute rule is one of the most important aspects of Medicare, and if you don’t know what it is, you could end up paying more than you need to for your coverage. In this blog post, we will explain what the 8-minute rule is and how it affects your Medicare coverage.
Medicare 8 Minute Rule Explained!
The eight-minute rule is a Medicare regulation that states that if a physician provides a service that is at least eight minutes long, Medicare will reimburse the physician for the entire service. This rule applies to both inpatient and outpatient services. If a physician provides a service that is less than eight minutes long, Medicare will only reimburse the physician for a portion of the service.
The eight-minute rule is important because it determines how much Medicare will reimburse physicians for their services. If a physician provides a service that is less than eight minutes long, they may not be reimbursed for the entire service. This could result in the physician losing money on the service. Please see the chart below for the breakdown according to the medicare 8-minute rule
How Does the 8-minute rule work?
These visits have to be done in person and have direct contact with the patient. If the visit exceeds 8 minutes they can bill for the full amount. If multiple things are being done during the visit Medicare will be billed on the total timed minutes per discipline.
The Services are billed in 15-minute units for the most part. So if a service took 19 minutes they can only bill for one unit of time. This is because the number of minutes falls between 8-22 minutes. Things are bundled in those time units moving forward.
What Kind of Dr.s or Services follow the 8 Minute rule?
- Private Practice
- Skilled Nursing facilities
- Rehabilitation Facilities
- Home Health Agencies covered Under part B of Medicare
- Emergency and Outpatient departments at hospitals
These are the most common practices in which the 8-minute rule is applied.
When Does the Rule not Apply?
- Medicaid
- Tricare
- Civilian Health and Medical Program of the Uniformed Services) CHAMPUS
Some examples of how medicare uses this!
Sheri visits the hospital where her physical therapist’s office is located. She receives 31 minutes of therapeutic exercise and 14 minutes of manual therapy. She then goes upstairs and receives an ultrasound, which takes nine minutes. The total number of minutes between services is 54, so Sheri’s Medicare plan will be billed for a total of four units of service.
As shown in the above example, the ultrasound is not billed separately. Since each service takes longer than eight minutes, the minutes are added together and billed to Medicare as the total number of units.
As another example, Bobby visits his physical therapist’s private practice. His physical therapist spends 16 minutes assessing his situation, 23 minutes on manual therapy, and seven minutes answering Bobby’s questions. This visit totals 46 minutes, so the office will charge Medicare for three units of service.
Keep Providers Honest
At times, providers are unaware of the full range of services for which they should bill, such as assessments, and evaluations. This results in underbilling. Therefore, patients should understand what Medicare can and should be charged for, so they can be confident they are not being overbilled. It is also crucial for providers to keep this in mind so they do not underbill for services.
This is good for providers and patients. This way everyone learns how to bill and pay effectively by applying this rule when using medicare with routinely occurring services like physical therapy, allergy care, and frequent Dr. visits.
We hope the above explanation of the 8-minute rule gives some clarity on how things are billed and why. We would like you to keep any questions coming our way. If you are in search of the right Medicare supplemental plan for your situation now is the time to reach out and see what we can do for you or your loved ones. We work with over 35 different carriers and have a ton of resources for you to take advantage of.
