Billing
How to bill for locum tenens services and
secure continuous care.
get proper coverage.
help more patients.
Medicare
If your currently employed physician is absent for the following reasons (but not limited to): vacation, illness, disability, CMEs, maternity leave, etc., or they have retired or left the practice, you can bill Medicare for services performed by the covering locum tenens physician under the absent physician’s NPI number as long as the following conditions are met:
- The employed/absent physician must be unavailable.
- The Medicare patient seeks care from the regular physician.
- The locum tenens provider is paid for their services on a per diem or similar fee-for-time basis.
- The employed/absent physician cannot bill for the services of the locum tenens physician for a continuous period for longer than 60 days at a time.
*Please note:
- If the employed/absent physician returns to work for a brief period, the same locum tenens physician can be rehired for another 60-day period.
- If the employed/absent physician is going to be gone for longer than 60 days (i.e., leave), the locum tenens physician will need to be enrolled as if they are a new provider.
- Records must be kept of each service the PT physician provided along with their new NPI number.
If these conditions are met, you can bill for the locum tenens physician’s services using the employed/absent physician’s NPI number. 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 number 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 number, 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 locum tenens 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’s name.
Non-Contracted Payers (Commercial Insurance)
Most commercial insurance plans will pay for locum’s services when billed under the regular physician’s NPI. If you are not contracted, credentialing is usually not required.
If the locum tenens physician was brought on 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 locum tenens 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
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