Q&A: Applying charges for therapy across different payers

Wednesday, October 30, 2019

Q: We are in the process of implementing a new EHR system. Our vendor has logic built for therapy charging based on both the AMA and the CMS eight-minute rules, and charges will generate differently based on the payer. We have always used the premise that charges/charging methodology should be applied the same to all patients, regardless of payer. 

How do others implement the eight-minute rules? How do you think using two charging methodologies in this world of price transparency will look?

A: We use the eight-minute rule for all payers, as the majority of our non-Medicare insurances have adopted it, to the point at which it would not make sense for us to implement two different charging methodologies. I would recommend double-checking on requirements from all insurances and reviewing the breakdown by revenue volume.

Editor’s note: This question was posted in the Chargemaster and Charge Capture section of the NAHRI Forums.