It seems that everyone in outpatient therapy knows about the “8-minute” rule with Medicare, right? Well apparantly not so when you hear of recent provider denials by the Recovery Auditor (RACs) reviews of therapy over the $3700 threshold, or the just released OIG report on Spectrum Rehabilitation LLC. I will have to chime in also – as an external auditor for therapy providers, both on routine and special projects, I am finding that therapy minutes and the 8-minute rule to be an area of key vulnerability for therapy practices. In fact, it may present the largest risk exposure a therapy practice has, that may not be showing up in annual risk assesments (assuming risk assessments are part of a working compliance plan). Take a few minutes today to ensure that daily notes in your practice are consistent with daily note reporting requirements.
A therapy daily note must document minutes in two parateters: 1) total timed codes treatment minutes, and 2) total treatment time (timed codes minutes and untimed codes minutes. Total treatment time is not necessarily equal to a subtraction of time in vs. time out. Patient may take a treatment break, have an extended no therapy warm-up session, or change clothes between aquatic therapy to land-based therapy. CMS regulations on documenting therapy minutes:
Total treatment time includes the minutes for timed code treatment and untimed code treatment. Total treatment time does not include time for services that are not billable (e.g., rest periods). For Medicare purposes, it is not required that unbilled services that are not part of the total treatment minutes be recorded, although they may be included voluntarily to provide an accurate description of the treatment, show consistency with the plan, or comply with state or local policies. The amount of time for each specific intervention/modality provided to the patient may also be recorded voluntarily, but contractors shall not require it, as it is indicated in the billing. The billing and the total timed code treatment minutes must be consistent.
Guidance on documenting minutes, which is a required element on the daily treatment note, is found in the Medicare Benefits Policy Manual, as well as in the Medicare Claims Processing Manual. Since 2006 (Transmittal 52) CMS has provided guidance on documentation of therapy minutes to support the codes that are billed. Every Medicare MAC has included this in their therapy educational offerings, and the CERT contractor continues to notes that a major source of therapy denials in CERT reviews are related to the inaccurate reporting of minutes to support the codes that were billed.
Stay tuned for how to calculate minutes.