Wiki How to bill out Locum Tenens?

[AmandaW]

Is Locum Tenens only for Medicare and how do you bill it out? What all is required on the electronic claim? Q6 modifier after each procedure and what else?? Or could at least guide me to where the exact guidelines are??

 

[jgf-CPC]

JGFisher

Remember to use Modifier Q6 on all your locum tenens claims. There are some extra steps that must be taken in order for your locum tenens claims to be reimbursed by Medicare. The Q modifier should be listed as a procedure code so Medicare knows you're claiming services rendered by a locum tenens physician. If you don't use the modifier, you claim will likely be denied. Also the maximum time limit for billing for locum tenens physicians is currently sixty days.

http://www.cms.hhs.gov/Transmittals/...ds/R1335CP.pdf

 

[jdrueppel]

Yes, you bill the Q6 modifier under the absent physician's name and billing number (both electronic and paper claims). The Q6 modifier informs Medicare/RRMC that this is a locum service so there is no need to formally notify MC and RRMC. Locum tenen coverage is only a physician recognized service so you can not bill the Q6 modifier for a non physician provider. I have attached the CMS weblink regarding locum services below (page 68 / section 30.2.11).

http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf

You will also want to check with your PPO carriers and Medicaid. Keep documentation of how they tell you to bill for the locum and the name of the person at the payer that provided the billing instructions. We had some that actually credentialed the locum provider and required we submit under the locum provider name/number. We had other commercial payers that did not credential the locum AND did NOT want the Q6 modifier on the claim but still instructed us to bill under the absent provider's name.

Hope this helps.

Julie, CPC