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Locum Tenens for an NP

  1. #1
    Location
    Overland Park, KS
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    1,166
    Default Locum Tenens for an NP
    Medical Coding Books
    I hate to sound dumb here, but I have a question regarding a locum physician. Can a locum physician replace an NP who is gone for 10 days? Who do we bill under? The NP? Still use Q6?

    I hope I don't sound too dumb here. Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    North Carolina
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    Default
    For the purpose of Medicare, I would say no.

    Palmetto: Services of nonphysician practitioners (e.g., CRNAs, NPs and PAs) may not be billed under the Locum Tenens or Reciprocal Billing reassignment exceptions. These provisions apply only to physicians.

    http://www.palmettogba.com/palmetto/...DID/7REK6H0542

    Trailblazers:These guidelines do not apply to providers other than physicians (i.e., Certified Registered Nurse Anesthetists (CRNAs), Physical Therapists (PTs), etc.).

    http://www.trailblazerhealth.com/Pub...m%20Tenens.pdf

    Although Chpt 1 of Medicare's Manual doesn't specifically exclude NPP, the citation(s) keeps referring to physicians.

    30.2.11

    http://www.cms.gov/manuals/downloads/clm104c01.pdf

  3. #3
    Location
    Overland Park, KS
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    Interesting! How then would we report this?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Location
    Overland Park, KS
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    Default
    Or is this even billible?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    Dawson,

    I believe I misinterpreted your question the first time I read it. The information I provided applies when a NPP fills in for a physicians leave of absense which isn't allowed. I'm still unclear about a physician filling in for a NPP. I'm still doing some reseach on this. If someone doesn't reply before I find the answer (I hope), I'll post what I find.

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Lightbulb
    Dawson,

    I have personally contacted our Medicare medical director and have been speaking with him a good portion of the day and he states that a physician can not function as a locum for a NPP. Locum tenens guidelines only apply for provider to provider. He went on to say (in your example) that you could hire either a physician or NPP to do the work, as long as they are appropriately licensed in NC (this represents my state), enrolled in Medicare and using their own name/number to bill, or assigned to your group number, as appropriate. So to answer your question, it appears your example is not billable unless the above requirements are met.
    Last edited by RebeccaWoodward*; 08-18-2010 at 11:19 AM. Reason: spelling

  7. #7
    Location
    Overland Park, KS
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    Thanks so very much for going above and beyond in this case! I will speak with my supervisor to see what our next step needs to be. I appreciate your help and I owe you one! Let me know when I can return the favor!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  8. #8
    Location
    North Carolina
    Posts
    3,126
    Default
    Not a problem at all. I actually had other unusual locum questions so I thought I would go ahead and ask all that I could since he was available.

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