# Locum Tenen CRNA!



## Melissa*Ever*Evolving (Dec 11, 2013)

Please help!

Anesthesiologist on maternity leave and the group is using a CRNA to fill in for the additional cases. How would I code this if the CRNA is not contracted with the group yet?

Would it be ok to bill under the MD with the AA Q6 modifiers or is this not allowable for a CRNA locum?

This CRNA has already done many cases and we are concerned on proper billing!

Quick responses much appreciated!

Thank you!

~Melissa, CPC


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## dwaldman (Dec 11, 2013)

You would place the charges for the CRNA in your biling system. You would put the charge on hold and not submit it to the carrier. Once you receive the letter they have a provider number/active provider. At that point you release the claim this could take between one to three months that you would hold until they are an active provider and you can release.

http://www.wpsmedicare.com/j5macpartb/resources/provider_types/mid-level-providers-qanda.shtml

Mid Level providers and Locum Tenens
Question: We have a mid level provider who is going on maternity leave. Can we use and bill for a locum tenens mid level provider while she is gone?

Answer: Locum tenens and reciprocal billing is only available for MD/DO. If you are hiring a temporary replacement for your mid level provider you will need to enroll the new person with Medicare. You can find more information in the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-04, Chapter 12Adobe Portable Document Format, Section 30.2.11.


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## dwaldman (Dec 11, 2013)

http://wpsmedicare.com/j5macpartb/claims/submission/reassign-nonphys.shtml

Reassignment by Nonphysician Practitioners

The purpose of this article is to clarify the reassignment exceptions, particularly locum tenens and reciprocal billing, as they apply to nonphysician practitioners. Because this is a national policy and providers are responsible for knowing the rules and regulations that apply to all services they bill to the Medicare program, claims received by this carrier that do not meet the provisions of this article will be denied.

Permissible exceptions to the reassignment prohibition are covered in section 1842(b)(6) of the Social Security Act. Section 1842(b)(6)(D) states that billing for substitute services may be done by a "physician for physician services furnished by a second physician to patients of the first physician." This provision contrasts with the other reassignment exceptions, which refer to a "physician or other person."

Accordingly, services of nonphysician practitioners [e.g., Certified Nurse Midwives (CNMs), Certified Registered Nurse Anesthesists (CRNAs), Anesthesia Assistant (AAs), Nurse Practitioners (NPs), Independent Physical Therapists (IPTs), Independent Occupational Therapists (IOTs), Independent Billing Psychologists, Clinical Psychologists (CPs), Clinical Social Workers (CSWs), Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs)] may not be billed under the locum tenens or reciprocal billing reassignment exceptions. These provisions apply only to physicians, as defined in 1861(r) of the Act.

Please also note that the Internet-Only Manual (IOM) 100-04, Chapter 1, Section 30.2.9Adobe Portable Document Format permits a physician or medical group to bill for purchased diagnostic tests; however, nonphysician practitioners may not bill for purchased diagnostic tests. Conversely, a test supplier may not bill for a purchased interpretation, unless the interpretation is done by a physician or medical group. Reassignment of nonphysician practitioner services is permitted under the following exceptions: 

Payment to employer 
Payment to an agent


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## Melissa*Ever*Evolving (Dec 17, 2013)

Thank you so very much that article was more than helpful!

~Melissa, CPC


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