Billing
What is the 8 minute rule?
The "8-minute rule" is a Medicare billing guideline that states a healthcare provider must spend at least eight minutes of direct, face-to-face patient care to be able to bill for one unit of a timed service, like physical therapy, meaning if a therapist provides less than eight minutes of treatment, they cannot bill for that service
How can you check your # of units/ visit? (2 options)
- Unit summary box in activities
- Charges
What template is required for a WC initial evaluation?
!IWT
Where should the Keet score documented in a note?
Subjective box
What is the goal for the number of visits per POC for a non-surgical case?
12 visits or less
What is the midpoint rule?
"Midpoint rule" refers to a system where a unit of time for a service is considered reached when the midpoint of the designated time frame is passed, meaning if a service is listed as requiring 15 minutes, a provider can bill for it if they spent at least 8 minutes (the midpoint) on the service, even if they didn't reach the full 15 minutes; this is often used for time-based codes in physical therapy and other medical procedures
What is our EBU goal per general visit?
4 units
T/F: The diagnosis code from the MD does not have to match the assessment or ICD-10 codes in my documentation?
False! ICD-10 should match the diagnos(es), in order, with the MD's script AND authorization
T/F: Subjective information must be updated each visit and should not include a running dated subjective history.
True
What is the goal for the number of visits per POC for a surgical case?
30 visits or less
Which rule follows the description below:
1. Add up the total time of all time based codes and divide the total by 15.
2.If the remaining amount is 8 minutes or above an additional unit can be charged.
What is our EBU goal for federal visits?
2
What are the 3 objective measurements are required to be documented in a PN for WC to be considered as a true progress note?
Summary of functional tolerance
ROM/MMT/ Pain
KEET score
How frequently do we need to submit a progress note for WC?
every 6 visits OR 14 days- whichever comes first
What is the goal for # of visits per day per full time therapist for efficiency?
12 or 1.5 patients per hour
If you performed 10 minutes of manual therapy and 8 minutes of Ther-ex, according to the 8 minute rule, how many units will you get?
10 + 8= 18 minutes
18/15= 1 unit
Remainder = 3 minutes
Total= 1 unit
What is NOT an EBU?
Service based units including:
- Group therapy
- Modalities
- Dry needling
- ESTIM- unattended
- Eval/ Re-eval
T/F: If a patient would benefit from additional care (work conditioning, FTE, etc), the only thing I need to do is document in my assessment.
False! This needs to be discussed with the case manager and/or adjuster first
T/F: Activities/ modalities require comments to include parameters.
True
What is our Keet collection and Met MCID goal?
80/80
If you performed 10 minutes of manual therapy and 8 minutes of Ther-ex, according to the midpoint rule, how many units will you get?
10 minutes MT= >8mins = 1 unit
8 minutes TE= 8 mins = 1 unit
Total= 2 units
Why are EBUs important?
Reimbursement, variety of care for patients, patient adherence to POC
What is required to have IN hand day of initial evaluation in order to treat WC?
- MD script WITH signature
- Authorization from WC
What needs to be updated in the goals section at each progress note?
Why is it important to achieve our KEET goals?
- Feedback from patient
- Insurance approval
- Graded as a clinic/ company by doctors for referrals