We have a situation where one of our clinics is open second shift. Our staff providers do not see patients during the second shift and leave for the day. The second shift is staffed by contact provider because we are short staffed. None of these providers are credentialed with the payer. How do we bill for this?
Also, some of the contract providers are NPs and PAs. We bill these mid level providers under the physician with the SA modifier. How can we report these visits since they are contract and not credentialed?
Here is the scenario:
The shift is 6pm-2:30am. 6-9pm is acute or routine care, billed to the patientâ€™s carrier. From 9pm to 2:30am the care is for Occ injuries. The coverage is provided by either a PA or NP depending on who is available to cover that second shift which again is from 6pm-2:30am. The only fulltime staff physicians we have presently are scheduled 8am-5pm or 9am-6pm, M-F and on a Saturday rotation from 8-12pm. Presently, all work is billed under our medical director as the rendering and billing provider for that second shift.
Can we bill these providers as locums under our Medical Director? They are not actually replacing our physicians, just filling-in because of a staffing issue? Thanks.
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P