Wiki Physical therapy help

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andersont

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Can someone help me with this please?

Is there a way to create a list of what insurances are under Medicare rules, and which we can use the Substantial billing practice with?

Thanks
 
Most of the reputable and larger billing and PT billing software vendors have this built in to the system. The practice can set it up as needed in the background and the system will automatically calculate it. Some of them will even prompt the therapist as to which to follow when they enter the chart for billing. However, you need to look at the provider manual and/or your contract for each payer. Many payers also have limits on the number of modalities/hours per day for outpatient.

I'm sure the APTA has guides in their practice management area if your therapists are members they have access to it. https://www.apta.org/your-practice/payment/coding-billing/coding-for-timed-codes

"The 8-Minute Rule applies not only to Medicare, but also to many different insurance plans, including some that fall under federal, state, and commercial purview. However, not every payer calculates units using the 8-Minute Rule, so best practice is to reach out to individual payers to confirm that this is the correct rule to follow."

Since it so often misunderstood and a highly audited area, it is one guideline that's really easy to find for most or all payers.

I found this easily with google but you would need to confirm it's actually correct.

Billing breakdown: 8-minute rule vs. SPM​

Payers who can be billed according to SPM:

  • Blue Cross Blue Shield
  • Aetna
  • Cigna
  • Auto (Geico, State Farm, Allstate)
  • Workman's Comp
The sources who require physical therapy be billed according to the 8-minute rule:

  • Medicare
  • Medicaid
  • Other Federal Payers:
    • Tricare (Armed Services)
    • Blue Cross for Federal employees
    • Champus (veteran's)
    • OWCP: Office of Worker's Compensation Program, administered by ACS
  • Medicare Advantage Programs
    • Medicare Plus Blue
    • Pyramid Life
    • Humana (advantage programs)
    • Aetna Advantage Plans
Primary vs secondary payers:

 
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