Re: 8 minute rule for Tricare

[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

>

>