Wiki Billing Locums without a signed agreement from provider who left

[slmclaughlin]

We have a provider who unexpectedly left the medical group. We have hired a locum tenen physician. However, we do not have a signed agreement from the provider who left that states we can bill any work the locum does under the absent provider's NPI.

We're at a loss as to how to proceed. Please advise.

 

[cyndeew]

The scenario you described does not meet the criteria for billing Locum Tenens - you are not holding the place of a physician that is returning within 60 days.

If you need a locum tenens physician for the traditional ?holding one?s place? type of scenario (e.g., coverage for vacations, illness/medical leave, continuing education, etc.), The Medicare Claims Processing Manual allows you to bill for locum tenens professional fees using the absent physician?s billing information as long as the following conditions are met:

• The regular physician is unavailable to provide the visit services.
• The patient has arranged or seeks to receive the visit services from the regular physician.
• The locum tenens provider is paid for his/her services on a per diem or similar fee-for-time basis.
• The substitute physician does not provide services to Medicare patients over a continuous period of longer than 60 days.

See http://www.bartonassociates.com/2012/07/25/billing-for-locum-tenens-services/ for good info on billing Locum.


http://www.bartonassociates.com/2012/07/25/billing-for-locum-tenens-services/#sthash.4tro065Q.dpuf

 

[mitchellde]

We have a provider who unexpectedly left the medical group. We have hired a locum tenen physician. However, we do not have a signed agreement from the provider who left that states we can bill any work the locum does under the absent provider's NPI.

We're at a loss as to how to proceed. Please advise.

You are left in a really bad position. These services are not billable. Hopefully you have other providers in the practice that can see these patients. As stated in the previous post you cannot hire a locum for a provider that is not expected to return.