Wiki NP / PA - Locums Billing

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ccat78

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For NPs and PAs (who are locums) and help to cover physicians who are out, what are the appropriate steps to bill for these NP/PA services? Does it change the regular billing workflow? Or, is there any modifier for the locums NP/PA status, assuming of course they are fully credentialed etc.? Thank you in advance for any help.
 
Locum Tenens does NOT apply to NP/PAs. You bill for their services exactly as you would any other NP/PA.
So - IF it meets incident-to (established pt, established problem, established plan of care, physician onsite), AND the carrier follows incident-to, you may bill under the onsite physician. If it does not meet incident to or the carrier does not follow incident-to, then it is billed under the NP/PA who actually provided the service, unless the carrier has a specific rule stating otherwise, and then bill according to carrier's written policy.
You may not bill your temporary NP/PA under the physician who is out. Probably not the answer you wanted to hear, but you will need to credential with insurance for these NP/PAs.

PS - CMS officially now calls it "Fee-for-Time", but it means the same as LT.
 
Last edited:
csperoni said:
Locum Tenens does NOT apply to NP/PAs. You bill for their services exactly as you would any other NP/PA.
So - IF it meets incident-to (established pt, established problem, established plan of care, physician onsite), AND the carrier follows incident-to, you may bill under the onsite physician. If it does not meet incident to or the carrier does not follow incident-to, then it is billed under the NP/PA who actually provided the service, unless the carrier has a specific rule stating otherwise, and then bill according to carrier's written policy.
You may not bill your temporary NP/PA under the physician who is out. Probably not the answer you wanted to hear, but you will need to credential with insurance for these NP/PAs.

PS - CMS officially now calls it "Fee-for-Time", but it means the same as LT.
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Thank you again for your help! A follow-up question to your helpful advice. A member of my team was asking about Modifier Q6 - but that is not applicable at all in this scenario, correct? Just wanting to confirm.
 
Correct, you would use Q6 only if you had a physician covering.

Here's a good article from Palmetto about using Q6 and specifies:
"Services of non-physician practitioners (e.g., CRNAs, NPs and PAs) may not be billed under the Fee-For-Service Time Compensation or reciprocal billing reassignment exceptions. These provisions apply only to physicians."
 
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