The 8 Minute Rule: Medicare vs. AMA

Making Sense of the Two Billing Rules

Previously, we’ve discussed Medicare’s 8 Minute Rule and the complexities associated with these guidelines.  However, some non-federally funded insurance companies use the American Medical Association’s (AMA) 8 Minute Rule guideline instead.  Are there discrepancies between these two 8 minute rules? Unfortunately, there are and it can complicate your billing practices. In this article, we’ll try to make sense of the two billing rules and explain the differences.

First, let’s take a brief look back at the Medicare guidelines.  For a visit, billable units can be divided into two types: Time-Based Units and Visit-Based Units.

Time-Based Units:  Based on Medicare’s guidelines, a procedure must be performed for a minimum of 8 minutes in order to be charged for a single unit, and multiple units of billing are allowed in 15-minute increments.  The total amount of billable units can be calculated by adding up all the minutes for time-based codes for that visit. The allowable units based on the total are as follows:

0 – 7 minutes = 0 units
8 – 22 minutes = 1 unit
23 – 37 minutes = 2 units
38 – 52 minutes = 3 units
53 – 67 minutes = 4 units

Visit-Based Units:  These procedure codes are not included in any time-based calculations, even if a time is entered.  These charges usually have a fixed amount of units associated with their code.

AMA Guidelines:  Now, we’ll discuss AMA’s 8 minute rule, also sometimes known as the Mid-point Rule.  The AMA uses similar guidelines as Medicare in that 1 unit equals 8 minutes. Where the AMA differs is that there is no cumulative restriction or adding of minutes, even for time-based codes.  Every code will be allowed 1 unit for each 8 minutes performed.

In other words, if you have leftover minutes from a combination of services, you would NOT be able to bill for any of these services UNLESS one of the services totals at least 8 minutes.

Let’s say you treated a patient for 40 minutes.  During this time, you performed 3 different therapies - one for 15 minutes, one for 13 minutes and one for 12 minutes.  Under the AMA guidelines, you would be able to bill for 3 units. You would not be able to add the excess minutes (over 8 minutes) bill for an additional billing unit.

Of course, there are always exceptions to these guidelines and the billing process for therapists can be daunting and confusing, even on the best of days.  How do you know if you are billing correctly or leaving money on the table? Conversely, how do you know if your billing submission will be denied, causing you more hassle and a delay in getting paid?  StrataPT can make sense of the ever-changing billing requirements. Our all-inclusive billing solution includes a team of dedicated billing professionals that provide unparalleled customer service, as well as the #1 accounts receivable collection rates in the industry.

We would love to hear from you!  To request a demo, please fill out the short form here and see how StrataPT can alleviate the stress, worry and time associated with your billing issues.

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