Get to Know the Secrets of Substantial Portion Methodology and 8 Minute Rule in Therapy Billing
Billing for therapy services can be a complex and confusing process, with different rules and regulations depending on the insurance carrier. To simplify billing, many therapists rely on Substantial Portion Methodology (SPM) and the 8 Minute Rule.
While both are used to determine how much time should be billed for a service, they differ in important ways that impact billing accuracy. In this article, we will explore the difference between both methods so you can understand which one might work best for your practice.
We’ll also discuss which insurance carriers comply with each rule. By understanding the subtleties of these two procedures, you will be better able to ensure accurate billing for your patients' therapy sessions.
What Is SPM?
8 minute rule is only applied to medicare payers, so most of the commercial payers don’t follow the medicare guidelines and this is where SPM comes into play.
It goes way similar to 8 minute rule but the main difference between the two is that under SPM a therapist cannot bill for leftover or remainder minutes.
Using the SPM method providers can actually bill more units which can ultimately bring more money to them.
How SPM and 8 Minute Rule Differ?
The 8 minute rule and Substantial Portion Methodology (SPM) are two commonly used methods for determining how much time should be billed for therapy services. While both methods are based on the same principle of tracking and billing for time spent providing treatment, they differ in important ways.
The 8 Minute Rule, which is used by Medicare payers, requires that a minimum of 8 minutes be billed for any service. Providers can bill for the leftover or remainder minutes at the end of a session.
Substantial Portion Methodology, on the other hand, when utilizing timed codes, such as those for 15-minute increments, is essential to ensure that a substantial portion of the allotted time is dedicated to performing the necessary pre-service, intra-service, and post-service work.
In order to accurately report and bill for these services, it is crucial to ensure that a significant amount of time is spent performing the physical therapy service. If only a minimal amount of time is dedicated to the service, it would not be appropriate to bill for that code.
Which Insurance Carriers Comply with Each Rule
When it comes to billing for therapy services, it is important to understand the differences between the 8 Minute Rule and Substantial Portion Methodology (SPM).
Each method has its own set of rules and regulations that may vary depending on the insurance carrier. It is essential to know which rule is being applied by the payer in order to ensure accurate billing.
For Medicare, Medicaid, and other federal payers such as Tricare (Armed Services), Blue Cross for Federal employees, Campus (veterans), Office of Worker’s Compensation Program administered by ACS,
Medicare Advantage Programs, Medicare Plus Blue, Pyramid Life, Humana (advantage programs), Aetna Advantage Plans, it is necessary to bill according to the 8 Minute Rule.
On the other hand, carriers such as Blue Cross Blue Shield, Aetna, and Cigna and auto insurance companies like Geico, State Farm, and Allstate as well as Worker's Comp policies can be billed according to SPM.
Last Words
In conclusion, it is essential for physical therapists to understand the differences between the Substantial Portion Methodology (SPM) and the 8 Minute Rule in order to ensure accurate billing.
By understanding which insurance carriers comply with each rule and how they are applied in practice, you can avoid any potential issues arising from incorrect or incomplete billing information.
With a little bit of knowledge of these two rules, you will be able to maximize reimbursement for your patients’ therapy services while also avoiding costly errors.
Ultimately, knowing both SPM and the 8 Minute Rule ensures efficient and accurate billing practices within your physical therapy clinic.
Get your therapy billing is done in the right way by considering the most affordable billing company in NY, HMS USA LLC now!
Comments