Documenting Time for Anthem BC Outpatient Therapy Patients

October 7, 2024
 / 
Rick Gawenda
 / 

Anthem BC is the largest BC carrier in the United States providing coverage in 14 states. In this article, I will answer the following questions regarding Anthem and what you must document for time for patients receiving outpatient therapy services:

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  1. For this statement – In the second policy, Anthem states you must document start and stop time for time-based procedures. – does this mean for we have to document the start and stop time for each timed service/code or the start/start time for the visit treatment time?

  2. What a stupid policy i.e. 97110 start 8:02 AM end 8:17 next they will ask to do it by the second.

  3. Crazy, how many of us start and stop between Ther Ex, Ther Act or Neuromusc Re-Ed? in 99% of the cases exercises we teach, activities we ask our patients to perform fall within these categories and we go back and forth between them. So, do we just break down total treatment time and assign a rather fictitious start and stop time to each? Thoughts?

  4. Thank you for this information. Do we know how long this policy has been in effect?

  5. Among other things, i.e., reimbursement, these are reasons we decided to no longer participate with Anthem. Do these rules also apply to out of network providers as well?

  6. We recently had this wording issue with a workers comp contract that read this way. I called the company and explained that the start and stop times for each code were not always continuous and this would be impossible to do. They clarified that they actually just needed the total start and stop time of the session and the total time for each CPT code, NOT the start and stop times for each CPT and the wording was incorrectly interpreted. Looks like I will need to call here as well. Unless someone has already done that?

    1. Anthem has been denying claims when start and stop time for each CPT code have not been documented.