Wiki Locum Tenens billing

[nklunk86]

We had a provider leave our practice who helped with delivery and in the next few months have an abundance of deliveries. With only having 3 providers they are looking at getting a locum tenens to help. My question is who do you bill under? Do we bill under the provider who left or one of the providers who are in office?

Also, for global billing of deliveries how do we handle this if billed under the locum since they are not credentialed with our practice, but our providers have done all the prenatal visits and will be doing the post-partum visits.

TIA

 

[Pam Warren]

If the provider is leaving permanently, you can't bill the new provider as a locum tenen. That is reserved for absent providers who are on a temporary LOA such as a deployment or sabbatical. You have two choices (essentially, the provider you bring on is a new hire).
Start credentialing for all payers ASAP. Medicare (and some commercials) will allow you to submit claims after credentialing is complete from the original date of the credentialing application[--so you hold your claims till credentialing is completed and then submit them at that time. Or you can bill incident-to the other providers, but that means you have to follow all incident-to rules....no new problems, no new patients, there has to be a plan of care in place, and a supervising provider in the the office. Commercial payers may have differing rules (you have to check).

 

[csperoni]

I agree with all Pam's advice. I would just add for global maternity billing, you are in a more unique situation as multiple providers will be providing care, but the billing may only be done by one provider. For any services being billed individually, you will absolutely need the new provider credentialed ASAP. For those being billed globally, I would bill under one of the existing providers involved in the maternity care.