Medicare Compliance & Reimbursement

Brush up on the ins and outs of locum tenens billing.

Scenario: One of your physicians will be out of the office for an extended period, and a fill-in physician will be taking her place. Follow these expert tips on billing using locum tenens to keep your office in compliance--and in the money--this summer.

1. Don't Confuse Q6 And Q5: Locum tenens providers are physicians taking another physician's place temporarily (note: they cannot fill in at a practice for more than 60 consecutive days) because of illness, pregnancy, vacation time or continuing medical education. HCPCS allows you to easily distinguish these services by appending modifier Q6 (Service furnished by a locum tenens physician) to the CPT procedure code for whatever service the locum provides.

Note that modifier Q6 is different from modifier Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement), which should not be used for locum tenens billing.

2. Fill Out the Claim Properly: "To bill for locum tenens, create the bill under the doctor they are filling in for but include a Q6 modifier on all procedures and place the locum UPIN in box 23 on the claim," explains Debbie Taube, medical records coder for Medical Management & Development in Charleston, S.C.

You should place the locum tenens physician's National Provider Identifier (NPI) or Unique Physician Identification Number (UPIN) in block 23 on the CMS-1500 form, and the NPI/PIN for your doctor who is absent goes in 33 and 24K (as it normally does). "The payor will pay the doctor who is absent but will be able to reference which doctor really performed the procedure," Taube adds.

Careful: Some carriers follow Medicare guidelines for locum tenens, but others have their own guidelines for fill-in-physician billing, so check first when using Q6 on a non-Medicare claim.

3. Avoid Logistical Pitfalls: Watch out for the following snags when billing for locum tenens services: Your physician must pay the locum tenens physician for services on a per-diem or similar fee-for-time basis for when he's filling in, Taube says.

Also, locum tenens allows your physician to receive payment for services another physician performs, but your physician cannot restrict the locum's services to your office.