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Billing for Locum

  1. #1
    Location
    Daytona Beach, FL
    Posts
    746
    Exclamation Billing for Locum
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    My supervisor has asked me to find out how we would handle coding and billing for a new OB Locum that is coming into our Hospitalist group...

    The issue is this doctor is coming to us as a Locum from a Locum agency and will be a Locum for 3-4 weeks, after which time they will be an employee of the hospital. Our hospital is in the process of purchasing an OB group practice, which is not going to take place until the end of September. Technically, the Locum is not filling in for a Hospitalist or doctor that is away or out, but is filling in for herself until the time she becomes an employee of our Hospitalist group and the contract has finalized with the OB group. I believe we need the Locum to fill in the area that has been vacated by one of the OB docs that is not staying with the group when they switch to the hospital.

    Hopefully this makes sense to someone - because this has totally confused me! Can someone tell me how we would bill for the Locum's services during this time period! Any help with this or direction as to where I can find this information would be greatly appreciated.
    Jodi Dibble, CPC

  2. Default
    The scenario you described doesn't sound like it qualifies for billing as Locum. The new provider isn't taking the place of another doctor who was scheduled to see patients.

    Medicare says this:
    See (http://www.cms.gov/manuals/downloads/clm104c01.pdf)

    H. Payment Under Locum Tenens Arrangements
    The B/MAC may pay the patient‘s regular physician for services of a locum tenens physician during the absence of the regular physician where the regular physician pays the locum tenens on a per diem or similar fee-for-time basis, and certain other requirements are met. (See §30.2.11.)

    B. Payment Procedure
    A patient‘s regular physician may submit the claim, and (if assignment is accepted) receive the Part B payment, for covered visit services (including emergency visits and related services) of a locum tenens physician who is not an employee of the regular physician and whose services for patients of the regular physician are not restricted to the regular physician‘s offices, if:

    The regular physician is unavailable to provide the visit services;

    The Medicare beneficiary has arranged or seeks to receive the visit services from the regular physician;

    The regular physician pays the locum tenens for his/her services on a per diem or similar fee-for-time basis;

    The substitute physician does not provide the visit services to Medicare patients over a continuous period of longer than 60 days subject to the exception noted below; and

    The regular physician identifies the services as substitute physician services meeting the requirements of this section by entering HCPCS code modifier Q6 (service furnished by a locum tenens physician) after the procedure code. When Form CMS-1500 is next revised, provision will be made to identify the substitute physician by entering his/her unique physician identification number (UPIN) or NPI when required to the carrier upon request.

    Even though you're not going to be billing a lot of Medicare since it's OB, many carriers have similar policies. You probably need to review each carrier's plan provisions and payment policies, but this doesn't sound like a true Locum situation until the practice is purchased.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    www.ambanet.net/AMBA.htm
    AMBACode Coding Software
    http://www.ambacode.net
    2015 AMBA National Medical Billing Conference
    http://www.ambanet.net/2015.htm

  3. #3
    Location
    Daytona Beach, FL
    Posts
    746
    Default
    Thanks Cyndee for your help. This is what I had thought and explained to them. They have decided to take a different approach to the situation which hopefully will work out. Otherwise I guess they will be providing free care for OB patients for the next 3 weeks!

    Thanks again.
    Jodi Dibble, CPC

  4. Default
    You're welcome!

    But keep in mind that the provider can see patients, she just won't be in-network. Perhaps she could give an in-network discount until she is credentialed...
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    www.ambanet.net/AMBA.htm
    AMBACode Coding Software
    http://www.ambacode.net
    2015 AMBA National Medical Billing Conference
    http://www.ambanet.net/2015.htm

  5. Default
    Do the services provided by the locum tenens get submitted by the provider he/she is filling in for? Is the locum identified on the claim form at all? Is Q6 used on all services the locum provides?

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