Billing Procedures

How to bill for locum tenens services

Working with locum tenens ensures patient access, continuity of care and an effective way to generate new revenue. Billing for services is straightforward, and is determined by the locum’s role and the length of the assignment.

To ensure proper billing, please review the following scenarios and ask your PhysiciansPRN consultant for advice on determining which method is right for you.


1

Replacing a doctor on leave,
Holding place of physician returning within 60 days,
Billing for LT coverage for an absent physician

1

Replacing a former physician who has retired or left the practice

MEDICARE

If your current employed physician is absent for the following reasons but not limited to: Vacation, Illness, Disability, CME’s, Maternity leave, etc. or they have retired or left he practice... you can bill Medicaid for services performed by the covering LT physician under the absent physicians NPI number as long as the following conditions are met:

  1. The employed/absent physician must be unavailable
  2. The Medicare patient seeks care from the regular physician
  3. The LT provider is paid for his/her services on a per diem or  similar fee-for-time basis
  4. The employed/absent physician cannot bill for the services of the LT physician for a continuous period for longer than 60 days at a time.

Notes:

  1. If the employed/absent physician returns to work for a brief period, the same LT physician can be rehired for another 60 day period.
  2. If the employed/absent physician is going to be gone for longer than 60 days (ie. Leave the LT physician will need to be enrolled as if he/she was a new provider.
  3. Records must be kept of each service the PT physician provided along with their NPI #.

If these conditions are met, you can bill for the LT physician’s services using the employed/absent providers NPI#. When submitting claims on the CMS-1500 form, all claims must contain the modifier Q6 after the procedure code of box 24D. Claims must also contain the NPI# of the employed/absent physician in box 24J.

MEDICAID

Most state Medicaid plans follow the CMS (Center for Medicare & Medicaid Services) guidelines. It is best to check the Medicaid rules of your state for guidance. If they do not allow billing under the employed/absent physician’s NPI#, you will need to follow normal enrollment procedures as if a new provider.

Contracted payers (HMOs, PPOs, etc.)

You will need to review your contract or insurance binder or contact your agent. Most payers allow billing for a LT physician under the regular physician’s name and NPI. However, in some cases payers will want to credential the locum physician prior to billing and will require you to bill under the locum name.

Non-Contracted payers (Commercial insurance)

Most commercial insurance plans will pay for locum services when billed under the regular physician’s NPI. If you are not contracted, credentialing is usually not required.


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Staffing up for New Growth
Meet rising demand
Peak Times
New service line

If the LT physician was brought on staff for a new service, growth, or peak season and will not be working for an employed/absent physician you will need to enroll that physician in Medicare, Medicaid, and all other contracted payers.

Billing for the services of locum tenens physicians can be a little tricky and timing is important, but it is well worth the investment of time when your reimbursements flow in as usual. Generally, the professional fees collected for services provided by a locum tenens physician more than cover their per diem rates and travel costs. Hiring locum tenens provides the double bonus of allowing you to maintain revenue and prevent patient attrition.

References and Links to information on Enrollment for LT Physicians

Center for Medicare and Medicaid Services (CMS)
http://www.cms.gov

American Academy of Professional Coders (AAPC)
http://aapc.com

Council for Affordable Quality Healthcare (CAQH)
http://www.caqh.org


We place generalist to specialist

From family practitioners to neurosurgeons, urologists to perinatologists, our network of locum tenens physicians bring care, craft and dedication to the job.

  • Anesthesiology
  • Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine
  • Dermatology
  • Emergency Medicine
  • Endocrinology
  • Family Practice
  • Gastroenterology
  • General Surgery
  • Gynecology Oncology
  • Hematology Oncology
  • Hospitalist
  • Internal Medicine
  • Medical Oncology
  • Neonatology
  • Nephrology
  • Neurology
  • Neurosurgery
  • Obstetrics & Gynecology
  • Orthopedic Surgery
  • Otolaryngology
  • Pathology
  • Pediatrics
  • Pediatric Critical Care
  • Pediatric Sub-Specialties
  • Pediatric Surgery
  • Perinatology
  • Plastic Surgery
  • Psychiatry
  • Pulmonology
  • Rheumatology
  • Thoracic Surgery
  • Urgent Care
  • Urology
  • & More…