We have a new arnp starting at our clinic this week. She is not credentialed with our office yet and probably will not be for several more months. I was told by my manager to use the modifer q6, and to list the supervising physican on insurance claims to get payment on the patients she will be seeing while we are waiting on her to get through credentialing. Everything i am reading online and just from reading the q6 modifier description, i do not feel this is legal billing? I am a very new coder so any advice on how or how not to use this modifier would be greatly appreciated. I am very concerned my certification could be on the line if i bill this way. I did what research i thought was necessary, but my manager asked me to get in touch with aapc memebers. Please help!
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Wiki Modifier q6- is this legal
- Thread starter JennT
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ellzeycoding
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No, that is not correct.
Q6 modifier is for a locum tenens situation when a provider is absentee (sick, vacation, sabatical) and another physician is filling in. Q6 would be applied to the claim to indicate locum tenens and billed under the regular physician's name and NPI number.
This is 100% different from your situation and billing like this would be fraudulent.
Many carriers will allow you to retroactively bill once credentialing is approved. Many will not allow services to be performed until the provider is credentialed. Check with each plan and your carriers.
Q6 modifier is for a locum tenens situation when a provider is absentee (sick, vacation, sabatical) and another physician is filling in. Q6 would be applied to the claim to indicate locum tenens and billed under the regular physician's name and NPI number.
This is 100% different from your situation and billing like this would be fraudulent.
Many carriers will allow you to retroactively bill once credentialing is approved. Many will not allow services to be performed until the provider is credentialed. Check with each plan and your carriers.
Pam Warren
True Blue
I am with Karl on this. I don't often use the "f" word, but this is clearly fraud.
Some payers will allow you to bill incident-to the physician, but you would absolutely have to read all your payer contracts first before you do this to make sure you are within compliance, and then you have the logistics of having to follow the incident-to guidelines.
CMS will allow several months grace period for billing after credentialing is complete. Please get that in place before you drop the claims under the APRN.
Some payers will allow you to bill incident-to the physician, but you would absolutely have to read all your payer contracts first before you do this to make sure you are within compliance, and then you have the logistics of having to follow the incident-to guidelines.
CMS will allow several months grace period for billing after credentialing is complete. Please get that in place before you drop the claims under the APRN.