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Locum Tenens ....

  1. #1
    Default Locum Tenens ....
    Medical Coding Books
    I completely understand the concept of locum tenens ... BUT this is a first for me. We had to fire a physician due to a reason so bad their license will probably be suspended or terminated. We've identified a locum tenens physician for 60 days. Since the physician that left license is at stake, do we still bill under them for 60 days? Quite frankly, we don't want to have anything to do with the doc that we fired, in any aspect. However, we still need to get paid for services rendered by the locums. My guess is the license process takes a while to be suspended, so it probably won't be for some time, but is it still proper to bill under them?

    The regs say that you can bill under a physician who left .... but doesn't regulate why the physician left.

    Anyone else had to deal with something like this?

  2. #2
    Default I don't see a problem.....
    As I understand locum tenens, I think you would be fine to bill under the physician that left, even if the reason is questionable. I did a seach for locum tenens (as I'm sure you did) and I can't find anything that would preclude you from billing under this doc.
    However, if you have a legal dept. I would CYA by checking with them.
    Hope this helps!


  3. #3
    This should be fine. That is one of the intents of locum tenens. I have previously had physicians that passed away suddenly and we brought in locums to cover their patients. I do know of a few instances where the physicians were fired due to various reasons and they used those numbers as well.

    The Q6 modifiers indicates the service was not provided by the physician it was billed under, so any issues that provider personally had would not be present in that visit.

    Now if your issue is they weren't even eligible to be a credentialed provider, ie forged documentation was used to obtain credentialing, I would not want to bill under that number either. In that situation I would think there is a very real probability they will take back any payments ever made to that provider.

    This is just my personal experience and opinion, and I agree with running everything thru legal first.

    Good luck,

    Laura, CPC

  4. #4
    Say the provider's license gets terminated/suspended as of today, July 21. (We KNOW this is going to happen, we just don't know when) The locums provides services, bills under the physician who left, starting July 21 for the next 60 days. We don't find out, say until September that the physicians license was revoked as of July 21. Will Medicare come and take all the money back?

  5. #5
    This appears to be old but basically states that once the provider loses their license they no longer have the right to bill Medicare.

    If that is the case, then I don't think locums would work. This is just my opinion based on what I have read though. I have not personally dealt with a situation in which a provider lost their license.

    Laura, CPC

  6. #6
    I certainly agree with you.

    Perfect, this is what I have been trying to get my hands on.

    Thanks so much.

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