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Question about locum tenens billing

  1. #1
    Default Question about locum tenens billing
    Medical Coding Books
    We have a situation where the administration has bought out the contract of a locum from the company he was working for. They now want to use him as a locum for one of our doctors who is going on leave. We believe he should now be considered an employee and should be credentialed with the ins cos we participate with. We need to find documentation which supports this. Does anyone have any suggestions? The info from the Medicare website says "generally" a locum is paid as a sub-contractor for the 60 days he works but we need something more concrete than this.

  2. #2
    The locum tenens rules are Medicare rules that allow for a physician practice to bill for a substitute, temporary physician under the provider number of a physician who has left the practice.

    The physician must be absent from the practice due to illness, vacation, CME or the physician may have left the practice
    The regular physician must be unavailable to provide the service
    This is a physician rule and may not be used for Non-Physician Practitioners (NPPs)
    There is a limit of 60 days for each locum physician, counted from the first day the locum sees a patient. This 60 days includes days that that locum does not see patients (the locum's day off)
    After 60 days, you may no longer bill for that locum. If services are still needed after that, the practice must find a different locum
    Bill for the locum under the NPI of the physician who is not there, and use the Q6 modifier on the claim
    You must keep a list of patients seen by the locum
    The regular physician pays the locum on a per diem, or a fee-for-time basis
    If post op care is rendered by the locum in the global period does not need to be identified on the claim form
    This may not be used when you are adding a physician and you have not enrolled the physician. Review the enrollment rules.
    There was an exception for the first half of 2008 which allowed physicians who were deployed on active duty in the Armed Forces to use a locum for longer than 60 days.

    This is a Medicare rule. Commercial insurances generally do not allow this type of billing.

    We got this from an attorney from a consulting firm for physicians. Hope it helps!

  3. #3
    Just because they bought out the contract doesn't mean this doctor is now an employee or will be starting a practice there. So it could still be perfectly fine to utilize them as a locum. I'm not saying it is because I don't know the ins and outs, just saying it could be.

    The info posted above is correct except for one thing,

    "After 60 days, you may no longer bill for that locum. If services are still needed after that, the practice must find a different locum "

    After 60 days the provider being covered either has to come back and work for at least a day in order to start another 60 day period or you can't bill under them at all using a locum. Locum tenens billing has nothing to do with the locum provider, at this time we don't even report who is doing it on the claim, it is based strictly on the status of the billing provider.

    Laura, CPC, CEMC

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