Results 1 to 3 of 3

Covering for a physician

  1. Default Covering for a physician
    Medical Coding Books
    We have a doc that is going to be out for 4-6 weeks, we have a mid level provider that could cover for him, how would we bill for his services? He would be billing out of White Bluff for the other doc instead of Gallatin.
    Last edited by glm516; 02-10-2012 at 11:58 AM. Reason: more info

  2. #2
    Locum tenens, or substitute, physicians usually assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, or continuing medical education. The substitute physicians generally have no practice of their own and move from area to area as needed. Medicare rules require that a locum tenens cannot provide services for longer than 60 days (see this exception [ PDF ] for physicians in the armed services; scroll to page 36). The regular physician generally pays the locum tenens a fixed-rate, per diem amount, with the locum tenens having the status of an independent contractor rather than an employee.

    The regular physician may submit the claim using the Q6 modifier (services furnished by a locum tenens physician). Additionally, the regular physician must keep on file a record of each service provided by the locum tenens along with the locum tenens' National Provider Identifier. Find all the details in the Medicare Locum Tenens/Reciprocal Billing ( PDF ) manual.

    Under reciprocal billing arrangements, a patient's regular physician may submit a claim and receive payment for the services arranged to be provided by a substitute physician on an occasional basis. The regular physician should identify the service as substitute physician services and bill with the Q5 modifier (service furnished by a substitute physician under a reciprocal billing arrangement).

    For commercial payers, the requirements may vary, making it necessary to determine billing procedures on a payer-by-payer basis

  3. #3
    Evansville Indiana
    Default mid level
    Is the mid-level already an employee of yours? Will there be another physician there when the mid-level is seeing patients? Since it is not another physician acting as the locum tenens there may be "incident to" issues to deal with.

Similar Threads

  1. One physician covering for another
    By Bilodeau in forum OB/GYN
    Replies: 1
    Last Post: 08-28-2016, 11:41 AM
  2. Covering Physician
    By SueTeal in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-25-2013, 10:47 AM
  3. New Physician Covering for Physician on Medical Leave
    By tnicholson in forum Billing/Reimbursement
    Replies: 2
    Last Post: 09-28-2012, 02:02 PM
  4. E&M for covering physician
    By llbarker in forum E/M
    Replies: 0
    Last Post: 08-19-2010, 10:24 AM
  5. covering physician
    By kellykletz in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 12-16-2009, 02:51 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.