Re: 8 minute rule for Tricare

[Guest guest]

Hi, Bonnie -

The " 8-minute rule " , ( or >8 <23 = 15 ) is a Medicare rule for Part B

outpatient services. TriCare is the former Civilian Health and Medical Plan

for the Uniformed Services, and is administered by private insurance

companies. You should review your own contract with TriCare to see what it

requires. It may -- or may not -- refer to a TriCare equivalent of the 8

minute rule. It would be wrong to assume that since it's Government, your

contract is the same as Medicare Part B outpatient PT.

One notable component of CHAMPUS which morphed into TriCare was that its

contracts with providers provided payment for PT services provided by a

licensed physical therapist. As a private practitioner at the time, I

received a denial for visits provided by my PTA, so I appealed them. My

position was that I owned the clinic, provided the equipment, and paid the

PTA, so I was the provider. Their position was that they pay for what their

contract specifies: Services by my own licensed hands, period. There would

be zero payment for the services of a PTA. So, the patient got " free "

service, and I received an education. I chalked it up to being tuition.

Last summer, I spoke with a private practitioner who has several clinics,

one of which is near a major military base. The patient load is reportedly

95% TriCare. I was told that the staffing is a PT and some " techs " or

aides, in a high-volume practice. Asking how they could use aides in a

TriCare clinic, I was told that their " ...state permits using aides... " in a

practice. When I asked what the contract's provisions are, the owner did

not know.

So, check your own contract, because that is what constitutes the law

between you and the TriCare administrator, as long as it doesn't conflict

with your practice act or professional Code of Conduct.

Dick Hillyer, PT, DPT, MBA, MSM

Dr. Hillyer

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Bonnie Gateau

Sent: Wednesday, February 22, 2012 7:31 AM

To: PTManager

Subject: 8 minute rule for Tricare

Hello Group

Does the 8 min rule also apply to Tricare patients since it is a federal

program. If there is documentation I can refer to please point me in the

right direction.

I welcome the input.

Bonnie Gateau, PT, CSCS

Gateau Physical Therapy/Medically Oriented Gym

Lusby, Md. 20657

410 326-3432

[Guest guest]

Hi, Bonnie -

The " 8-minute rule " , ( or >8 <23 = 15 ) is a Medicare rule for Part B

outpatient services. TriCare is the former Civilian Health and Medical Plan

for the Uniformed Services, and is administered by private insurance

companies. You should review your own contract with TriCare to see what it

requires. It may -- or may not -- refer to a TriCare equivalent of the 8

minute rule. It would be wrong to assume that since it's Government, your

contract is the same as Medicare Part B outpatient PT.

One notable component of CHAMPUS which morphed into TriCare was that its

contracts with providers provided payment for PT services provided by a

licensed physical therapist. As a private practitioner at the time, I

received a denial for visits provided by my PTA, so I appealed them. My

position was that I owned the clinic, provided the equipment, and paid the

PTA, so I was the provider. Their position was that they pay for what their

contract specifies: Services by my own licensed hands, period. There would

be zero payment for the services of a PTA. So, the patient got " free "

service, and I received an education. I chalked it up to being tuition.

Last summer, I spoke with a private practitioner who has several clinics,

one of which is near a major military base. The patient load is reportedly

95% TriCare. I was told that the staffing is a PT and some " techs " or

aides, in a high-volume practice. Asking how they could use aides in a

TriCare clinic, I was told that their " ...state permits using aides... " in a

practice. When I asked what the contract's provisions are, the owner did

not know.

So, check your own contract, because that is what constitutes the law

between you and the TriCare administrator, as long as it doesn't conflict

with your practice act or professional Code of Conduct.

Dick Hillyer, PT, DPT, MBA, MSM

Dr. Hillyer

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Bonnie Gateau

Sent: Wednesday, February 22, 2012 7:31 AM

To: PTManager

Subject: 8 minute rule for Tricare

Hello Group

Does the 8 min rule also apply to Tricare patients since it is a federal

program. If there is documentation I can refer to please point me in the

right direction.

I welcome the input.

Bonnie Gateau, PT, CSCS

Gateau Physical Therapy/Medically Oriented Gym

Lusby, Md. 20657

410 326-3432

[Guest guest]

Thanks Dick

We called Tricare today and they confirmed our current belief that they do

not adhere to the 8 min rule. Appreciate the information.

Bonnie Gateau

> **

>

>

> Hi, Bonnie -

>

> The " 8-minute rule " , ( or >8 <23 = 15 ) is a Medicare rule for Part B

> outpatient services. TriCare is the former Civilian Health and Medical Plan

> for the Uniformed Services, and is administered by private insurance

> companies. You should review your own contract with TriCare to see what it

> requires. It may -- or may not -- refer to a TriCare equivalent of the 8

> minute rule. It would be wrong to assume that since it's Government, your

> contract is the same as Medicare Part B outpatient PT.

>

> One notable component of CHAMPUS which morphed into TriCare was that its

> contracts with providers provided payment for PT services provided by a

> licensed physical therapist. As a private practitioner at the time, I

> received a denial for visits provided by my PTA, so I appealed them. My

> position was that I owned the clinic, provided the equipment, and paid the

> PTA, so I was the provider. Their position was that they pay for what their

> contract specifies: Services by my own licensed hands, period. There would

> be zero payment for the services of a PTA. So, the patient got " free "

> service, and I received an education. I chalked it up to being tuition.

>

> Last summer, I spoke with a private practitioner who has several clinics,

> one of which is near a major military base. The patient load is reportedly

> 95% TriCare. I was told that the staffing is a PT and some " techs " or

> aides, in a high-volume practice. Asking how they could use aides in a

> TriCare clinic, I was told that their " ...state permits using aides... " in

> a

> practice. When I asked what the contract's provisions are, the owner did

> not know.

>

> So, check your own contract, because that is what constitutes the law

> between you and the TriCare administrator, as long as it doesn't conflict

> with your practice act or professional Code of Conduct.

>

> Dick Hillyer, PT, DPT, MBA, MSM

>

>

>

> Dr. Hillyer

> Hillyer Consulting

> Cape Coral, FL 33914

>

>

>

> _____

>

> From: PTManager [mailto:PTManager ] On

> Behalf

> Of Bonnie Gateau

> Sent: Wednesday, February 22, 2012 7:31 AM

> To: PTManager

> Subject: 8 minute rule for Tricare

>

>

> Hello Group

> Does the 8 min rule also apply to Tricare patients since it is a federal

> program. If there is documentation I can refer to please point me in the

> right direction.

> I welcome the input.

> Bonnie Gateau, PT, CSCS

> Gateau Physical Therapy/Medically Oriented Gym

> Lusby, Md. 20657

> 410 326-3432

>

>

[Guest guest]

Hi Dick and Bonnie,

To reinforce part of Dick's post:

Tricare, due to a quirk in their own Department of Defense regulations, will

not allow payment for PTA services in a private practice setting. It is

entrenched in the military bureaucracy and unchangeable for the near future.

I have recently been a Tricare provider and I am not aware of an 8 minute

rule but as Dick said it is something that you should be able to check in

the contract or with your local Tricare representative. For instance, here

in Idaho Tricare is administered by Regence Blue Shield of Idaho and there

is a Blue Shield provider rep that we can contact for questions. In your

state, you should have a similar set up.

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

From: PTManager [mailto:PTManager ] On Behalf

Of Dick Hillyer

Sent: Wednesday, February 22, 2012 4:12 PM

To: PTManager

Subject: RE: 8 minute rule for Tricare

Hi, Bonnie -

The " 8-minute rule " , ( or >8 <23 = 15 ) is a Medicare rule for Part B

outpatient services. TriCare is the former Civilian Health and Medical Plan

for the Uniformed Services, and is administered by private insurance

companies. You should review your own contract with TriCare to see what it

requires. It may -- or may not -- refer to a TriCare equivalent of the 8

minute rule. It would be wrong to assume that since it's Government, your

contract is the same as Medicare Part B outpatient PT.

One notable component of CHAMPUS which morphed into TriCare was that its

contracts with providers provided payment for PT services provided by a

licensed physical therapist. As a private practitioner at the time, I

received a denial for visits provided by my PTA, so I appealed them. My

position was that I owned the clinic, provided the equipment, and paid the

PTA, so I was the provider. Their position was that they pay for what their

contract specifies: Services by my own licensed hands, period. There would

be zero payment for the services of a PTA. So, the patient got " free "

service, and I received an education. I chalked it up to being tuition.

Last summer, I spoke with a private practitioner who has several clinics,

one of which is near a major military base. The patient load is reportedly

95% TriCare. I was told that the staffing is a PT and some " techs " or

aides, in a high-volume practice. Asking how they could use aides in a

TriCare clinic, I was told that their " ...state permits using aides... " in a

practice. When I asked what the contract's provisions are, the owner did

not know.

So, check your own contract, because that is what constitutes the law

between you and the TriCare administrator, as long as it doesn't conflict

with your practice act or professional Code of Conduct.

Dick Hillyer, PT, DPT, MBA, MSM

Dr. Hillyer

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of Bonnie Gateau

Sent: Wednesday, February 22, 2012 7:31 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: 8 minute rule for Tricare

Hello Group

Does the 8 min rule also apply to Tricare patients since it is a federal

program. If there is documentation I can refer to please point me in the

right direction.

I welcome the input.

Bonnie Gateau, PT, CSCS

Gateau Physical Therapy/Medically Oriented Gym

Lusby, Md. 20657

410 326-3432

[Guest guest]

Hi Dick and Bonnie,

To reinforce part of Dick's post:

Tricare, due to a quirk in their own Department of Defense regulations, will

not allow payment for PTA services in a private practice setting. It is

entrenched in the military bureaucracy and unchangeable for the near future.

I have recently been a Tricare provider and I am not aware of an 8 minute

rule but as Dick said it is something that you should be able to check in

the contract or with your local Tricare representative. For instance, here

in Idaho Tricare is administered by Regence Blue Shield of Idaho and there

is a Blue Shield provider rep that we can contact for questions. In your

state, you should have a similar set up.

M.Howell, P.T., M.P.T.

IPTA Payment Specialist

Meridian, Idaho

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

From: PTManager [mailto:PTManager ] On Behalf

Of Dick Hillyer

Sent: Wednesday, February 22, 2012 4:12 PM

To: PTManager

Subject: RE: 8 minute rule for Tricare

Hi, Bonnie -

The " 8-minute rule " , ( or >8 <23 = 15 ) is a Medicare rule for Part B

outpatient services. TriCare is the former Civilian Health and Medical Plan

for the Uniformed Services, and is administered by private insurance

companies. You should review your own contract with TriCare to see what it

requires. It may -- or may not -- refer to a TriCare equivalent of the 8

minute rule. It would be wrong to assume that since it's Government, your

contract is the same as Medicare Part B outpatient PT.

One notable component of CHAMPUS which morphed into TriCare was that its

contracts with providers provided payment for PT services provided by a

licensed physical therapist. As a private practitioner at the time, I

received a denial for visits provided by my PTA, so I appealed them. My

position was that I owned the clinic, provided the equipment, and paid the

PTA, so I was the provider. Their position was that they pay for what their

contract specifies: Services by my own licensed hands, period. There would

be zero payment for the services of a PTA. So, the patient got " free "

service, and I received an education. I chalked it up to being tuition.

Last summer, I spoke with a private practitioner who has several clinics,

one of which is near a major military base. The patient load is reportedly

95% TriCare. I was told that the staffing is a PT and some " techs " or

aides, in a high-volume practice. Asking how they could use aides in a

TriCare clinic, I was told that their " ...state permits using aides... " in a

practice. When I asked what the contract's provisions are, the owner did

not know.

So, check your own contract, because that is what constitutes the law

between you and the TriCare administrator, as long as it doesn't conflict

with your practice act or professional Code of Conduct.

Dick Hillyer, PT, DPT, MBA, MSM

Dr. Hillyer

Hillyer Consulting

Cape Coral, FL 33914

_____

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ] On

Behalf

Of Bonnie Gateau

Sent: Wednesday, February 22, 2012 7:31 AM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: 8 minute rule for Tricare

Hello Group

Does the 8 min rule also apply to Tricare patients since it is a federal

program. If there is documentation I can refer to please point me in the

right direction.

I welcome the input.

Bonnie Gateau, PT, CSCS

Gateau Physical Therapy/Medically Oriented Gym

Lusby, Md. 20657

410 326-3432