# Billing for covering physicians



## mojisola (Jun 22, 2017)

Can someone please tell me how to bill for covering physicians not linked to my practice TIN and get pd. I billed claims with the Q5 mod and i was told the physician still has to be linked to the practice.
Suggestions???


----------



## pdesanti65 (Jun 22, 2017)

Q6 modifier Lucum Tennans


----------



## thomas7331 (Jun 22, 2017)

Covering physicians from another practice normally bill their own charges themselves, from their own practice's billing system.  I don't know of many payers that would allow you to bill another practice's physician's charges under your TIN with modifier Q5.  If you are going to bill for them and pay them for their services, you'll probably need to enroll or credential them with the payers as part of your own practice.  

The locum tenens is not the same thing as 'covering'.  The locum tenens Q6 modifier would apply only if the covering physician was replacing one of your physicians during a leave of absence and for a limited period of time - if that's the case, you would bill under your own physician's credentials and add the Q6 modifier.


----------



## Cynthia Hughes (Jun 22, 2017)

*Billing for covering physician*



mojisola said:


> Can someone please tell me how to bill for covering physicians not linked to my practice TIN and get pd. I billed claims with the Q5 mod and i was told the physician still has to be linked to the practice.
> Suggestions???



Hi,

The physician providing services under a reciprocal billing arrangement is invisible on the claim which includes the name and NPI of the physician for whom the provider is covering. The regular physician bills with the Q5 modifier and payment is made to the regular physician's practice. For Medicare billing, Chapter One of the Medicare Claims Processing Manual, Sections 30.2.1 and 30.2.10 describe the associated rules for billing under reciprocal billing arrangements. The regular physician bills with the Q5 modifier and payment is made to the regular physician's practice.

30.2.1
G. Payment Under Reciprocal Billing Arrangements
The B/MAC may pay the patient’s regular physician for services provided to his/her patients by another physician on an occasional reciprocal basis. (See §30.2.10.)

30.2.10
The 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) which the regular physician arranges to be provided by a substitute physician on an occasional reciprocal basis, if:
• The regular physician is unavailable to provide the visit services;
• The Medicare patient has arranged or seeks to receive the visit services from the regular physician;
• 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 in item 24d of Form CMS-1500 HCPCS code Q5 modifier (service furnished by a substitute physician under a reciprocal billing arrangement) after the procedure code. When Form CMS-1500 is next revised, provision will be made to identify the substitute physician by entering the unique physician identification number (UPIN) or NPI when required on the form and cross-referring the entry to the appropriate service line item(s) by number(s). Until further notice, the regular physician must keep on file a record of each service provided by the substitute physician, associated with the substitute physician’s UPIN or NPI when required, and make this record available to the carrier upon request.

See Section 30.2.10,A if the physicians are in the same group practice.

You may need to verify how private payers treat reciprocal billing. Most Medicaid plans allow reciprocal billing similar to Medicare but it is best to verify in your provider manual.

I hope this helps.
Cindy


----------



## mojisola (Jun 22, 2017)

Thanks for the response but the problem is not all of the insurances recognizes the q6 modifier. 
Meaning I have to bill under my providers credentials and call it a day.


----------



## mojisola (Jun 22, 2017)

This is actually my first time using this medium and am glad I did. Very detailed and insightful response. 
Thanks


----------



## thomas7331 (Jun 23, 2017)

mojisola said:


> Thanks for the response but the problem is not all of the insurances recognizes the q6 modifier.
> Meaning I have to bill under my providers credentials and call it a day.



Billing another provider's services under your provider's credentials without using the appropriate modifier to report that you are doing so could be considered a false or fraudulent claim - I would strong recommend against that.


----------

