Get the Most Out of Locum Tenens Physicians
By Delly Parham, CPC
Using locum tenens physicians to fill in for regular physicians may cost your practice instead of helping it if you don’t understand how to bill for their services. To ensure you get paid and stay in compliance, you must adhere to Medicare and commercial payer guidelines.
Practices usually use locum tenens (Latin for “lieutenant”) physicians when the regular physician is absent because of vacation, illness, childbirth, business, education, active duty, or having left the practice. The advantages of hiring a locum tenens physician versus using a physician in the same practice or in the same area are that it:
- Retains the regular physician’s existing patients
- Introduces new patients to the practice
- Maintains the patient level
- Keeps revenue with the regular physician
Most practices using the services of a locum tenens go through a recruiting agency, such as Comp Health. These companies handle the licensing requirements, professional liability insurance, and screening of the locum tenens, taking the liability and burden off practices. The practice or group pays the recruiting agency, and the agency pays the locum tenens physician. If your practice chooses to hire the locum tenens directly, you must:
- Check your state licensing laws for licensing requirements. Most – if not all – states require physicians to be licensed in that state.
- Check with your professional liability insurance carrier.
- Make sure the locum tenens is in good standing and get his or her professional liability insurance certificate, verifying it covers the services the locum tenens will be performing for the regular physician.
Whether you use a recruiting agency or hire the locum tenens physician directly, the practice must:
- Train staff with information about locum tenens physician to retain patients with the regular physician and give them incentive to see locum tenens without fear, for example:
- The locum tenens is temporary and will only see them once or for a short period of time.
- The locum tenens’ experience and expertise as a physician.
The period for which a single locum tenens physician may substitute cannot be more than 60 continuous days. The 60-day period begins the first day the locum tenens physician provides services for Medicare patients of the regular physician. An exception to this 60-day rule is for regular physicians who are called to active duty in the armed forces. The time is unlimited. See Social Security Act at section 1842(b)(6)(D.)
The regular physician:
- Must schedule appointments under his or her schedule.
- Is the only physician who can break the locum tenens’ 60-day period.
- May re-set the 60-day period by returning to practice and see patients only one day after the initial 60-days and use the same locum tenens.
- Must bill for the services of the locum tenens.
- Must put his or her National Provider Identification (NPI) number on all filed claims.
- May use more than one locum tenens to substitute for absences during the 60-day period.
- May reimburse the locum tenens a fixed amount per diem or similar fee for time.
- Must keep a record of each service furnished by the locum tenens physician and the NPI.
A locum tenens physician:
- Fills in for the regular physician for 60 continuous calendar days.
- Can substitute only if the regular physician is absent for any of the reasons above.
- Cannot substitute more than 60 continuous calendar days, unless there is a break in the 60-day by the regular physician.
- Cannot re-set the 60-day clock by taking a day off.
- Generally does not have a practice of his or her own and moves from area to area as needed.
- Is usually an independent contractor of the regular physician or group rather than an employee.
- Does not have to be enrolled in the Medicare program to see Medicare patients
- Cannot be a non-physician practitioner (e.g., NPs, CRNAs, PAs).
- Cannot bill Medicare for services within the 60-day continuous period in his or her name or NPI.
The regular physician bills and receives payment from Medicare and other payers who follow Medicare’s guidelines for the locum tenens physician’s services as though the regular physician performs the services. The regular physician must put the regular physician NPI in box 24J and his or her name in box 31 of CMS 1500 and the regular physician or group name and NPI in box 33 of the CMS 1500. Other Medicare rules include:
- Use the name and NPI of the regular physician or group.
- Use modifier Q6 after the procedure code (Q6 identifies services by locum tenens physician).
- If the only service a locum tenens physician performs is post-operative for an operation within a global period, it cannot be billed with Q6 modifier because the regular physician is paid a global fee, and it’s not necessary to include the service on the claim.
- If a regular physician requires the locum tenens physician to provide services for longer than 60 continuous days without a break, the locum tenens physician must enroll with the practice.
Other payers have different rules. TRICARE requires that non-contracted locum tenens physicians complete a certificate or other document to be linked to the regular physician or group tax identification number. Some Medicaid programs (e.g., Florida Medicaid) require the locum tenens physician bill under his or her own name and NPI. Blue Cross Blue Shield adheres to the guidelines of Section 125b of the Social Security Act. (BCBS Manual for Physicians and Providers, May 2010).
Medicare Claims Processing Manual, chapter 1, section 30:2.11