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Part B Insider (Multispecialty) Coding Alert

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13 Tips for Recouping Payment for Substitute Physicians

Hint: Don't mix up modifiers Q5 and Q6. Although you can't bill locum tenens for new physicians who haven't been credentialed yet (see previous page for more), you can use locum tenens or reciprocal billing in other situations, such as when your doctor is on vacation. You can avoid unnecessary stress during physician vacations when you report reciprocal billing arrangements or locum tenens services for your doctor. Keep this clip-and-save checklist handy for quick how-to advice on applying modifiers Q5 and Q6. 1. Know What Reciprocal Billing Means. Remember that reciprocal billing allows a physician to submit claims and receive Medicare payments for services that he has arranged for a substitute physician to provide on an occasional, reciprocal basis. 2. Get to Know Modifier Q5. To appropriately report services a physician performs under a reciprocal billing agreement, use modifier Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement). [...]