Fusion has the option to allow you to calculate units based on the CMS Guidelines or the "8-Minute Rule." This is especially helpful when working with Medicare and other payers that follow this rule.
What is the Difference?
CMS Guidelines are used primarily in the adult sector. Especially when Medicare is the primary payer. In order to ensure that Fusion is able to support your clinic in all of your billing needs, it is important to include this as you enter new payer information.
How Units Are Calculated
- The AMA method used to calculate units is, per charge line, the minutes for that line divided by 15 (rounded to the nearest integer).
CMS 8-Minute Rule
- CMS 8-minute rule takes the sum of minutes for all charge lines divided by 15 to determine the total number of units that can be distributed among the charge lines.
NOTE: Fusion will distribute those units first to charge lines with the most number of minutes remaining, then to charge lines with the highest per-unit fee
What happens if a billing code ends up with 0 units since claims that have a charge line with 0 units get rejected?
Timed billing codes with 0 units will not appear on the claim, but will still appear on the document to show what work was done and where the minutes are assigned.
Since the primary payer determines how units are calculated if a patient has a non-Medicare payer as the primary and Medicare as the secondary, how will the secondary get the correct units?
Both payers could be set to calculate units “By Total Minutes”.