American College of Physicians: Internal Medicine — Doctors for Adults ®

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Quick tips for billing locum tenens doctors

From the June ACP Internist, copyright 2010 by the American College of Physicians

A practice may need to take on a locum tenens physician (a physician who does not have a practice of his or her own) for a variety of reasons, ranging from the temporary leave of a colleague to the permanent absence of a physician who has left the group. Employers are increasingly looking at locum tenens staffing as a solution to permanent vacancies, in part because of physician shortages, but also because they see the appeal of trying out potential employees before making a permanent hiring decision.

Here are a few tips that may help practices weather the storm when deciding on how to appropriately bill and submit claims for a locum tenens physician:

Q: We have a doctor who is leaving our practice in a month’s time. We need to get a locum tenens for hopefully less than a 60-day period. Can we bill under our previous physician’s National Provider Identifier (NPI) number until we get another permanent doctor to join the practice and have the payment come to the practice?

A: If a practice decides to contract a locum tenens physician to provide services for patients of a physician who permanently left the practice, the same rule applies as for a physician who is on maternity leave or vacation. The regular physician bills and receives payment for the substitute physician’s services as though he or she performed them. Services should be reported with modifier Q6, and the time period cannot exceed 60 days. Once the 60-day period has passed, the group practice will no longer be able to bill the locum tenens physician’s services under the former physician’s NPI number.

Q: What should practices do when the locum stays beyond the 60-day period allowed by Medicare?

A: A continuous period of covered visit services begins with the first day on which the substitute physician provides covered visit services to the regular physician’s Medicare patients. The period ends with the last day the substitute physician provides services to these patients before the regular physician returns to work. This period continues without interruption on days when no covered visit services are provided to patients on behalf of the regular physician, for up to a maximum of 60 days.

If it is necessary to retain the substitute physician for more than 60 days, contract a new locum tenens, or the current locum tenens physician must enroll with his or her Medicare carrier and bill the days beyond the initial 60 days in his or her own name and with his or her NPI number. The regular physician may, however, bill and receive payment for the services that the substitute physician provides on his or her behalf for 60 days or fewer.

Q: I have a physician who has just come back from six weeks of maternity leave; in her absence we used a locum tenens. She has been back for one week and needs to take another two weeks. The locum that we used in her absence is available; are we allowed to use this locum again?

A: Yes, based on Medicare guidelines. As long as there is a break after the initial 60 days of locum tenens service, you can use the same locum tenens to provide services again. The break doesn’t have to be extensive; it can be as brief as the regular physician returning to the office for one day, as long as the date or dates the physician returned to see patients are documented and identifiable by Medicare.

Q: Is a locum tenens physician required to be enrolled in Medicare to provide services to Medicare patients?

A: A locum tenens physician must go through the Medicare credentialing process and be approved as a credentialed Medicare provider prior to seeing Medicare patients. A record of the locum tenens physician’s NPI must be on file with the carrier. The locum tenens physician’s services must be billed using the modifier Q6 to show that a locum tenens physician provided care, and a record of the services provided to your patients by the locum tenens physician must be kept on file.

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