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Annie Posted 1 Year(s) ago
I need some guidelines for billing locum tenens cleared up. I have a locum that covered this weekend. He is not covering for a specific hospitalist, we just have some open shifts to fill due to physicians leaving. The last physician left more than 3 months ago, but is still on staff just not working shifts at our facility. I am sure they have moved on. Can I bill the locum as covering for that physician, if not, how do I bill the locum?
SuperCoder Posted 1 Year(s) ago

Hi,

 The physician who has left the group and for whom the group has engaged a locum tenens physician as a temporary replacement may bill for the temporary physician or locum for up to 60 days.

The group must enter in item 24d of Form CMS-1500 the HCPCS modifier Q6 after the procedure code.

The group must keep on file a record of each service provided by the substitute physician, associated with the substitute physician’s UPIN or NPI when required, and make this record available to the carrier upon request.

In addition, the medical group physician for whom the substitution services are furnished must be identified by his/her provider identification number (PIN) or NPI when required on block 24J of the appropriate line item. 

Physicians who are members of a group but who bill in their own names are generally treated as independent physicians for purposes of applying the requirements of subsection A for payment for locum tenens physician services. Compensation paid by the group to the locum tenens physician is considered paid by the regular physician for purposes of those requirements. The term “regular physician” includes a physician who has left the group and for whom the group has hired the locum tenens physician as a replacement.

Most payers will allow billing for a locum under the regular physician’s name and NPI. However, some payers will want to credential the locum physician prior to billing and will require you to bill under the locum name. If the payer has delegated credentialing to you, the timeline for this can be quite short. If you must rely on the insurance company, allow 30–60 days for their credentialing process. Some payers will pay retroactively to the first date of service and some will only pay claims with dates of service after the finalization of the credentialing process. Please find undermentioned links for more clarification.

Hope this helps!

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1486CP.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c01.pdf

Posted by Annie, 1 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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