SuperCoder Posted Thu 22nd of September, 2011 01:19:08 AM
My Doctor goes on vacation he has another radiologist read for him, do we just bill as usual or do we use the modifier q6 ( for medicare)
SuperCoder Answered Thu 22nd of September, 2011 04:09:06 AM
When one of your staff physicians takes a leave of absence for any reason and a substitute physician fills in, you need to add the Q6 modifier to Medicare claims the substitute physician handles if you want to ensure reimbursement for the services that the substitute physician provides.
This lets the Medicare carrier know that you are coding for a locum tenens physician. Without the modifier, you’ll likely receive a denial for the claim.
Since many private carriers are adopting more and more of Medicare’s standards for payment on services; before filing a locum tenens claim with a private insurer, verify with the plans as to their requirements for locum tenens billing — and whether or not they even recognize it. Some good questions to ask are:
-Do you recognize modifier Q6?
-Which provider’s ID should be reported for the services?
-Does the locum tenens provider need to be credentialed with the payer, even if only temporary privileges?