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Old 04-25-2012, 02:57 PM
Cindyev67 Cindyev67 is offline
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Default Question regarding a locun tennan

if I have a locun tennan can I bill him under our group versus under a physician. Basically I have a locum tennan that is filling in while we are recruiting new doctors, so I don’t have a specific doctor he is “covering” so can I bill under group, and I know I have to have a modifier Q6.
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Old 04-25-2012, 03:43 PM
cblack712 cblack712 is offline
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The physician the locum is covering for can be considered a member of the group until a perm replacement has been found per CMS guidelines, therefore you should still be using that physicians name. Here is the excerpt from the CMS manual (chapter 30.2.11 sec c)
"Medical Group Claims Under Locum Tenens Arrangements
For a medical group to submit assigned and unassigned claims for the services a locum
tenens physician provides for patients of the regular physician who is a member of the
group, the requirements of subsection B must be met. For purposes of these
requirements, per diem or similar fee-for-time compensation which the group pays the
locum tenens physician is considered paid by the regular physician. Also, a 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 for up to 60 days. The
group must enter in item 24d of Form CMS-1500 the HCPCS modifier Q6 after the
procedure code. Until further notice, 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"
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