Does Medicare’s 8-Minute Rule Apply to Inpatient Acute Care Therapy Services?

June 17, 2024
Rick Gawenda

If a Medicare beneficiary is admitted into the hospital and receives therapy services as an inpatient, Medicare’s 8-minute rule does

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  1. Does the Critical Access Hospital designation effect that interpretation for acute or observation status?

  2. If not 8 minute rule as defined by Medicare- then default is rule of 8s via ama? We provide contract inpatient therapy- and our payment is determined by number of cpts billed- so doing our best to be compliant but effective with our billing. What about all the pre-treatment time- such as chart review, nurse collaboration, lab value check involved with treating a patient- billable time?

  3. Does the Medicare 8 minute rule apply to physical therapy services provided to acute care patients in a critical access hospital?

  4. Are all services in an inpatient acute care setting reimbursed via diagnosis related groups (DRGs)? Or is that a payor to payor decision?