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Thread: How to bill Locum Tenens

  1. #1
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    Question How to bill Locum Tenens

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    I'm not sure if this is on the right forum, but I have a question about billing for Locum Tenens.

    We have submitted our claims for Lcoum Tenens in our Hospitalist group and for one of our surgeons with the Q6 modifier, but now our billing company is telling us that they are being denied by Medicare because the note written by the doctor must indicate that they are in fact a locum tenum providing the documented services. I have tried to find documentation to support this, but have not been able to find anything so far.

    Does anyone know if this is the case and if so, where I can find it in writing. I need proof to show to the docs otherwise they will fight us about adding anything else to their documentation!

    Thanks for the help!
    Jodi Dibble, CPC

  2. #2
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    Default

    Do you know the denial code used by your Medicare contractor? It would be easier to respond if you knew the precise reason for denial. Locum tenens is addressed in the Medicare Claims Processing Manual, Chapter 1, Section 30.2.11 on page 69 of the PDF: http://www.cms.gov/manuals/downloads/clm104c01.pdf
    Jenny Berkshire, CPC, CEMC, CGIC

  3. #3
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    Default

    Jenny - Thanks for the response.

    I don't know which code they denied the claim with, (unfortunately we have a new billing company and I don't have access to our EOB's) but according to the message from the billing company, it was denied for Medical necessity. When the billing co. called Medicare they say they were told that the reason for the denial was that the notes had to state that the services were provided by a Locum Tenens performing the services. I had read the Medicare Claims processing manual Ch. 1, 30.2.11 and could not find any passage saying what the documentation of the note had to contain. The instructions written there just say to submit the claim with the Q6 modifier and this shows that the Locum Tenens administered the services. We did that but the claims were denied!

    I'm just wondering if anyone else has had this issue and if their Locums include in their documentation a statement that the visit was administed by a Locum Tenen.

    Thanks,
    Jodi Dibble, CPC

  4. #4
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    Apr 2007
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    1,716

    Default News to me...

    Who is your Medicare carrier?

    We use locums quite frequently and they document what they did just like a regular doctor would. No mention of them being a locum. I have had no problems as yet.

    I have had an issue in the past where they utilized locums past the 60 day mark and the provider being covered had not been back. We had to back all those charges off and refund, they paid them though which is strage. I'm sure they would have found it eventually if we hadn't.

    I think you need more info from the billing company. I have a billing company that sends me emails saying something denied. I spend a couple hours (not always, sometimes it just feels that way) researching only to find out they were wrong and it didn't reject for the reason they told me.

    Laura, CPC, CPMA, CEMC

  5. #5
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    Default

    Thanks Laura - Our Medicare carrier is Highmark. I was thinking the same thing about the billing company - I have had alot of issues in the past with them not having the correct information. It is such a process with this company - they e-mail another person in my office - the "contact person" - and then she has to pass the e-mail over to me. Then when I find the answer, I have to give it back to her to contact the billing company. I feel like I'm playing a game of Telephone, never quite sure if I am getting all the correct information.

    I think I will contact Highmark directly to see what is going on. I think something is wrong here too because the Hospitalists have been using Locums for awhile and I'm sure we have been paid in the past.

    Thanks for your help.
    Jodi Dibble, CPC

  6. #6
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    Greeley, Colorado
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    Question

    Does the Locum Tenens guideline also apply to commercial insurance? If so, would you still need to use the Q6 modifier?
    Lisa Bledsoe, CPC, CPMA

  7. #7
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    Default

    That is a good question - I don't know but I know here the billing append the Q6 to all of the charges, regardless of where they are going. I would be interested in knowing that answer too, if some one knows!
    Jodi Dibble, CPC

  8. #8
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    Default

    Tell the billing company to send you a copy of the EOB. If it is a medical necessity denial then the locum tenens issue does not matter. I have a question, if the payer denied the claim as suggested in the first response by the billing co for medical necessity, then they "called" the payer and were told the bit about the documentation, how did the payer know whether or not the locum tenens documented this information? I provided consulting for a billing comapany and what I heard the people there tell clients on the phone made my hair curl! They would tell clients all manner of things that were not at all true, I would hear this and immediately go look it up and slide the correct responses under their nose but it never mattered. So you should see the actual EOB afterall the billing service is YOUR employee not the other way around.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    Daytona Beach, FL
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    Default

    Thanks Debra - I agree. There is an issue with this billing company - and yes we have caught them quite a few times telling us bogus information. I think they think that we don't know anything about the billing process here. They do not seem to think they are our employees either - they treat us as if we work for them! I acutally cannot (not allowed) contact the company directly - I have to go through another employee in this office who is designated as the contact to get the info I need! I have no idea what possessed our Hospital in signing up with this company, but they are horrific! I used to do all the billing for the hospital Urgent Care - and now I have no access to this information - it is so frustrating!!

    I am putting in a request to get the EOB - if they will allow me access. If not, I will contact Highmark myself to see what is really going on.
    Jodi Dibble, CPC

  10. #10
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    Default

    You go girl! Ask highmark for a copy of the EOB sometimes they will give you one.

    Debra A. Mitchell, MSPH, CPC-H

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