Question Need Q6 usage clarification please

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My office has always been a One doctor practice until a couple months ago and the original doctor is out on medical leave. Unfortunately the new doctor is not credentialed with all the insurances yet (mainly UHC). My question is can I bill claims under regular provider using the Q6 modifier when treating provider is employed by our practice. I have been given conflicting answers... Yes because your Dr. is only out for a few weeks, No because he is employed with your practice. Any thought would bee appreciated.
 
See here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c01.pdf
30.2.11 - Payment Under Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements) - Claims Submitted to A/B MACs Part B

You are saying, your practice was a one doctor practice, yet recently hired a second physician to be employed by the practice as a regular provider, and they are not fully credentialed yet? The new, second doctor may not just be billed as locum if they are waiting for credentialing and are employed (not fee for time arrangement contractor) by the practice. This is a bad plan.


Some plans *might* allow retroactive billing where you can hold the claims until credentialing is complete, not sure how many still allow it these days. You need to check with all of the health plans and your contracts to see what the policy is. In general, it is not advised to do any of these at all.
 
You're welcome. There can be nuances to it. The contracts for each health plan would need to be checked to see what they say about this. You said "until a couple of months ago". Hopefully the credentialing process was started very early and is almost done...?
Sounds like they might need a true locum provider to step in.
The only other options are the provider pending credentialing only sees certain patients such as self pay, plans where retro would be allowed (confirmed w/ the payer), or post op (if you are a surgical type practice). If a patient has out of network benefits this might be an option, but most patients are not going to like that. Depends on the type of practice, if you are PCP or specialty, etc.
 
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