how can a physical therapist see 11 patients in 8 hrs medicare

Do physical therapists need to keep track of Medicare billing?

Physical therapy practice owners in America have a lot going on from scheduling and treating clients, to running a profitable small business covering marketing, accounting, and much more. If you have to add keeping track of PT Medicare billing nuances to the list, it’s more than most therapists can handle.

What is the 8-minute rule for Medicare physical therapy billing?

Medicare physical therapy billing works in increments of 15. So what are you supposed to do when your treatment only takes 13 minutes to complete? That’s where the eight-minute rule comes in. You only have to spend eight minutes with a patient to be able to bill for one “15-minute” unit.

How many patients can a physical therapist see in a day?

While there's no hard and fast rule at the federal level about the number of patients a PT can see in a day, some state practice acts may specify a number. During our 2017 industry survey, we found that the number of patients a PT sees in a day greatly depends on use of PTAs, PT techs, and other extenders.

How does Medicare pay for physical therapy?

Medicare has a copayment of 20% of the Medicare-approved amount under Medicare Part B (for outpatient therapy). The Medicare-approved amount is the amount you as the physical therapist agree to be paid for services rendered, and the client is responsible for the remaining 20%.

How often does a PT have to see a Medicare patient?

The PT must recertify the POC “within 90 calendar days from the date of the initial treatment,” or if the patient's condition evolves in such a way that the therapist must revise long-term goals—whichever occurs first.

Can a physical therapist treat more than one patient at a time?

What are group therapy services? According to CMS, “Group therapy consists of simultaneous treatment to two or more patients who may or may not be doing the same activities.

What is the 8-minute rule and how is the time billed for two units?

Introduced in December 1999, the 8-minute rule became effective on April 1, 2000. The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes. A billable “unit” of service refers to the time interval for the service.

What is the Medicare 8-minute rule?

The 8-minute rule is a stipulation that allows you to bill Medicare insurance carries for one full unit if the service provided is between 8 and 22 minutes. As such, this can only apply to time-based CPT codes. But, the 8-minute rule doesn't apply to every time-based CPT code, or every situation.

When reporting time based treatment time the therapist includes what time?

A treatment encounter note is required to include two-time elements: the total time-based treatment minutes and the total treatment minutes. The total treatment minutes includes both time spent providing time based and untimed code services.

What is concurrent physical therapy?

First, concurrent therapy is defined as one therapist treating two Medicare patients at the same time. For example, the therapist starts treatment directly with a patient, who is beginning a specific task.

How many units can you bill for PT?

Per Medicare rules, you could bill one of two ways: three units of 97110 (therapeutic exercise) and one unit of 97112 (neuromuscular reeducation), or. two units of 97110 and two units of 97112.

What insurances follow 8-minute rule?

Please note that this rule applies specifically to Medicare Part B services (and insurance companies that have stated they follow Medicare billing guidelines, which includes all federally funded plans, such as Medicare, Medicaid, TriCare and CHAMPUS). The rule does not apply to Medicare Part A services.

How do you maximize physical therapy billing?

Ten Ways Physical Therapists Can Maximize BillingSet goals. As a therapist, you've got a lot of experience in the goal-setting department. ... Track your progress. ... Increase efficiency. ... Educate yourself and your staff. ... Clean up your claims. ... Digitize. ... Know your payer mix. ... Keep an eye on cash flow.More items...•

How many units is 52 minutes?

3 unitsMinutes and Billing Units8 – 22 minutes1 unit23 – 37 minutes2 units38 – 52 minutes3 units53 – 67 minutes4 units68 – 82 minutes5 units1 more row•Sep 13, 2018

How many units is 45 minutes?

3 billable unitsTimed Minutes: 45 However, billing is based ultimately on total timed minutes – 45 in this case, and equivalent to 3 billable units. Those 7 minutes spent on therapeutic activity still count toward timed minutes because Therapeutic Activity is a timed code.

Can a physical therapist bill for documentation time?

You can't bill for documentation. Documentation takes time—there's no denying that. Even if you have an EMR system that streamlines the process, there's still a lot of effort that goes into creating notes that are complete, correct, and compliant.

How long does Medicare bill for physical therapy?

Understanding the Medicare 8-Minute Rule for Physical Therapy Billing. Medicare has certain rules and regulations in place to prevent fraud, waste, and abuse. Here’s one you may not have heard of – the 8-minute rule. Providers must treat patients for at least eight minutes to receive Medicare reimbursement.

How many minutes of manual therapy are there on Medicare?

However, you have two “remaining” minutes from the physical exercise and six “remaining” minutes from the manual therapy. Together, you have eight minutes, which would push you into the next billing unit. Medicare guidelines would allow you to bill for three units in that circumstance.

What is CPT code?

As you may know, CPT codes are medical codes that describe the procedures and services you are performing to billing agencies and insurance companies. They were created by the American Medical Association in 1966 to simplify and standardize procedural reporting.

How long do you have to be on Medicare for treatment?

The 8-minute rule states that to receive Medicare reimbursement, you must provide treatment for at least eight minutes. Using the “rule of eights,” billing units that are normally based on 15-minute increments spent with a patient can be standardized.

How many units of Medicare would you be billed for if you completed 23 minutes of treatment?

However, if you completed 23 minutes of treatment, Medicare would be billed for two units of treatment. The bill would still be for two units regardless of whether you spent 23 or 30 minutes with the patient.

What is the 8 minute rule?

By definition, the 8-minute rule applies to Medicare, Medicaid, TRICARE, and CHAMPUS. Private insurance carriers may choose to operate the same way, but by rule are not required to. Medicare beneficiaries who enroll in private Medicare plans (Medicare Advantage) may also have different billing standards depending on the plan.

How many billing units can you bill for 45 minutes?

Technically, you’ve just spent 45 minutes with the patient, which would equate to three billing units. However, those first 25 minutes only counted for one unit because you were not in the room for the whole time, and you were not performing one undivided task. Therefore, you can only bill for two units.

How many minutes of treatment do you need to be on Medicare?

For time-based codes, you must provide direct treatment for at least eight minutes in order to receive reimbursement from Medicare. Basically, when calculating the number of billable units for a particular date of service, Medicare adds up the total minutes of skilled, one-on-one therapy and divides that total by 15. If eight or more minutes are left over, you can bill for one more unit; if seven or fewer minutes remain, you cannot bill an additional unit.

How long do you have to be on Medicare for a treatment?

For time-based codes, you must provide direct treatment for at least eight minutes in order to receive reimbursement from Medicare. Basically, when calculating the number of billable units for a particular date of service, Medicare adds up the total minutes of skilled, one-on-one therapy and divides that total by 15.

What is the 8 minute rule for rehab?

Rehab therapists use the 8-Minute Rule—or the slightly variant “Rule of Eights”—to determine the number of units they should bill Medicare for the therapy services provided on a particular date of service. Prev.

How many minutes of 97110 are in a single visit?

For example, say a therapist bills 10 minutes of 97110 and 10 minutes of 98116 in a single visit. Those codes are considered unique services, and are counted separately. Each service lasted longer than eight minutes, so the therapist can bill for two units total: one unit of 97110 and one unit of 98116.

What are the codes for a therapist?

Time-based (or constant attendance) codes, on the other hand, allow for variable billing in 15-minute increments. You would use these codes for performing one-on-one services such as: 1 therapeutic exercise (97110) 2 therapeutic activities (97530) 3 manual therapy (97140) 4 neuromuscular re-education (97112) 5 gait training (97116) 6 ultrasound (97035) 7 iontophoresis (97033) 8 electrical stimulation (manual) (97032)

How long is a manual therapy session?

Let’s say that on a single date of service, you perform 30 minutes of therapeutic exercise (EX), 15 minutes of manual therapy (MT), 8 minutes of ultrasound (US), and 15 minutes of electrical stimulation unattended (ESUN). To correctly calculate the charge in accordance with the 8-Minute Rule, you would add the constant attendance procedures ...

Do CPT codes include assessment and management time?

However, according to John Wallace, WebPT’s Chief Business Development Officer of Revenue Cycle Management (RCM), CPT codes actually do make allowances for assessment and management time.

What is part B in physical therapy?

Physical therapy. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. outpatient physical therapy.

What is Medicare approved amount?

Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. , and the Part B deductible applies.

What is the purpose of Part B documentation?

From Medicare’s perspective, the primary purpose of all Part B documentation is to demonstrate that the care fully supports the medical necessity of the services provided. That means a Progress Report must clearly describe how the services are medically necessary for that patient.

Can progress reports be billed separately?

It’s also important to remember the time involved in writing a progress report cannot be billed separately. Like all documentation, Medicare considers it included in the payment for the treatment time charge. Progress Reports do not need to be a separate document from a daily treatment note.

Is rehabilitation therapy reasonable?

If an individual’s expected rehabilitation potential is insignificant in relation to the extent and duration of therapy services required to achieve such potential, rehabilitative therapy is not reasonable and necessary.”. In terms of rehabilitative therapy the terms improvement, expectation, reasonable and predictable period ...

What does Medicare expect from you?

Medicare expects you to evaluate the patient, determine their rehabilitation needs and address those needs. One of those inaccurate impressions is the belief the patient must be making objective progress in order to continue with rehabilitation.

How long is Medicare billing?

When billing timed CPT codes, Medicare not only looks at the individual 15-minute units but also considers the total time when factoring the allowable payment. This is commonly known as the 8-23-minute rule.

What does the KX modifier mean for PT?

The KX modifier simply indicates to Medicare that specific treatment continues to be medically necessary and requires the skills of the PT/OT in order to continue towards meeting the patient’s goals. This serves as a mental check on whether the care continues to be reasonable and necessary.

What is the TPE program?

CMS now uses the Target ed Probe and Educate program (TPE) to review selected claims and educate providers on Medicare billing requirements. Currently, the CMS is targeting only those practices with the highest denial rate or with billing practices that are substantially different than their peers.

How did Medicare come into existence?

Medicare came into being through legislation, signed into law by President Lyndon Johnson, as part of the Social Security Amendments of 1965. It’s funded by payroll deductions as an addition to your Social Security deductions (FICA) as well as premiums paid for those receiving Part B benefits.

What is important about Medicare?

One of the more valuable things about Medicare is they tell you exactly what they are looking for in their documentation requirements. For starters, documentation must support the medical necessity of the care provided. This means your notes must be comprehensive enough and contain sufficient detail so anyone reviewing the medical record may easily see what you are treating and why you are providing that specific treatment. They should also be able to easily see if there is progress towards achieving the patient’s functional goals.

How many units are needed for 15 minutes of exercise?

For any service provided for at least 15 minutes you must bill 1 unit. Sometimes that’s easy: if you provide 15 minutes of Therapeutic Exercise you bill 1 unit of that code, 30 minutes of Neuromuscular Re-education is 2 units of that code. However, this is where Medicare’s totaling of the time complicates things.

How long does Medicare require for outpatient services?

Since Medicare requires the 8-minute rule to be followed for these in-person, outpatient services, providers do not have the choice of using another billing method.

How many minutes does Medicare take?

The services are then billed in 15-minute units. Therefore, if a service or services take (s) 20 minutes, Medicare will be billed for one unit, because the number of minutes falls between eight and 22. If 23 to 37 minutes is spent on the service (s), Medicare can be billed for two units. If the service (s) take (s) 38 to 52 minutes, ...

What is the 8 minute rule for Medicare?

What is the Medicare 8-Minute Rule? Medicare’s 8-minute rule is a stipulation that applies to time-based CPT codes for outpatient services, such as physical therapy. Introduced in December 1999, the 8-minute rule became effective on April 1, 2000.

How long does Medicare bill for in-person services?

The 8-minute rule applies only to services where the practitioner has direct contact with the patient. Therefore, the service must be in-person for the 8-minute rule to apply. If you’ve received more than one service, Medicare will be billed based on total timed minutes per discipline. If an individual service takes less than eight minutes, ...

How long is Medicare billing?

The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes. A billable “unit” of service refers to the time interval for the service. Under the 8-minute rule, units of service consist of 15 minutes each.

Is an ultrasound billed separately?

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, Gregory visits his physical therapist’s private practice.

Is Medicare overbilled?

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.

What is balance in physical therapy?

As a physical therapist, balance is intrinsic to your job—whether that be striking a balance between motivating patients and not pushing them too hard or treating patients for literal balance issues. And PTs have to find balance for themselves, too—though maybe not as literally as vestibular patients. In 2017, we surveyed thousands of rehab therapy ...

Why is my patient not achieving his or her goal?

Of course, there are many reasons why a patient may not be achieving his or her outcome goals, such as the patient’s inability to complete home exercises or lack of investment in therapy. However, as the provider, it’s your responsibility to notice any blockers—and find resolutions to them.

Do PTs spend more time with each patient?

Does your team strive for quality over quantity? Does your practice use specialized modalities or treatment methods? That fact is, no two clinics have an identical culture. And depending on the culture of your clinic, PTs may spend more or less time with each individual patient. Furthermore, if—as mentioned above—a practice leverages extenders, thus leaving therapists to primarily conduct evaluations, then that could also impact the number of patients a therapist sees in a day, as evaluative visits generally take longer and require more one-on-one time than standard treatment visits do.

Can a PT see a lot of patients?

So, a PT may technically see a large number of patients in a day, but that volume may not be sustainable or realistic without the help of such extenders.

Is physical therapy a cookie cutter profession?

Physical therapy isn’t a cookie-cutter profession. In fact, if you had a room full of physical therapists, each provider would likely report a very different day-to-day experience. There are many factors that contribute to this variation—all of which impact how many patients any given provider can realistically treat in a single day.

Does satisfaction score matter if you look at less patients?

I think the satisfaction scores should improve, doesn't matter if you look at less patients or more. That's what matters, even if you see less patients, but give them good treatment, they will remember you for good!

Can patients tell when you're seeing too many patients?

You’re not the only one who’s impacted by your daily schedule. Whether or not they realize it, your patients can tell when you’re seeing too many patients—and when you’ve struck a happy medium. The fact is, patients don’t want to feel like products on an assembly line.

How long can a therapist bill for a supervised modality?

In the same 15-minute time period, one therapist may bill for more than one therapy service occurring in the same 15-minute time period where "supervised modalities" are defined by CPT as untimed and unattended -- not requiring the presence of the therapist (CPT codes 97010 - 97028). One or more supervised modalities may be billed in the same 15-minute time period with any other CPT code, timed or untimed, requiring constant attendance or direct one-on-one patient contact. However, any actual time the therapist uses to attend one-on-one to a patient receiving a supervised modality cannot be counted for any other service provided by the therapist.

How often is 97150 billed?

In private practice settings for physical and occupational therapists and in physician offices where therapy services are provided incident to the physician, Medicare expects the group therapy code (97150) to be billed only once each day per patient. In the facility/institutional therapy settings, the group therapy code could be applied more than once. However, the occasional situation where group therapy is billed more than once each day would require sufficient documentation to support its medical necessity and clinical appropriateness of providing more than one separate session of group therapy.

Can a therapist bill a patient separately?

Therapists, or therapy assistants, working together as a "team" to treat one or more patients cannot each bill separately for the same or different service provided at the same time to the same patient.

What is clinical training and appropriate supervision?

Clinical training and appropriate supervision are crucial, but facilities and individual practitioners need to pay close attention to guidance from the Centers for Medicare and Medicaid Services to ensure that they remain in compliance with requirements related to services to Medicare beneficiaries. See other resources on supervision and teamwork.

Can a physical therapist be used with Medicare?

Physical therapy aides must be used carefully depending on the Medicare setting. Get clarification on the circumstances under which students may participate in the provision of outpatient therapy services to Medicare patients. Some requirements related to student involvement can vary depending on the setting.

Introduction

See more on webpt.com

What Are Service-Based Cpt Codes?

What Are Time-Based Cpt Codes?

What’s The Deal with Mixed Remainders?

So What Is The Rule of Eights?

Does Assessment and Management Time Count Toward The 8-Minute Rule?

What’s The Best Way to Avoid 8-Minute Rule Mistakes?