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  1. #1
    Overland Park, KS
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    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 patient'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, CRHC, AAPC Fellow

  2. #2
    Phoenix, AZ
    You need to look closely at your contract under the locum and NP/PA sections. You should follow the guidelines. However, IMO the billing should not go out under the medical director unless he on site. Again, it depends on the wording of your contract. The wording will determine whether or not the staffing needs to change.

    Also check with your WC carrier. A lot of times, they have a short turn around for credentialing and will credential short term/contract providers. At least, that was the case in WA state.

    Good luck!
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  3. #3
    Overland Park, KS
    Thanks so much!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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