Medicare Compliance & Reimbursement

Use these Q&As as a reference if one of your physicians goes on scheduled leave.

There could be various reasons why one of your doctors schedules a leave of absence -- illness, travel, or something else. If someone else is hired by your practice to fill in until he returns, it's time to brush up on answers to some of the most common locum tenens questions.

1. What Does "Locum Tenens" Mean?

The term "locum tenens" literally means "placeholder," and refers to a person who temporarily takes the place of another. In the medical world, locum tenens physicians temporarily take the place of another physician to handle that workload for a certain period of time.

Heads up: Medicare has a 60-day limit for a locum tenens physician. Your practice cannot extend this time period, according to the Medicare Claims Processing Manual (Chapter 1, Section 30.2.11).

2. How Do We Code for Locum Tenens Service?

HCPCS includes a modifier that immediately lets payers know that you're reporting locum tenens services: Q6 (Service furnished by a locum tenens physician).

Keep these tips in mind when preparing locum tenens claims, says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.:

• Modifier Q6 is meant for claims that represent physician services, not CRNAs. The only exception is if the payer has a policy stating you can submit Q6 for a CRNA's services when that CRNA is hired to fill in for another CRNA.
• Append modifier Q6 to every procedure code on a claim for the locum tenens physician.
• Send the bill out under the regular physician's name and National Provider Identifier (NPI).
• Use modifier Q6 when reporting locum tenens services to Medicare. Check other payment guidelines for locum tenens policies before submitting claims. Medicare payment rules typically apply to Medicaid, and some private payers also follow Medicare guidelines.

3. How Should We Report Multiple Providers?

More than one physician might fulfill locum tenens duties for your anesthesiologist.

Scenario 1: Your physician is out of the office for more than 60 days, which goes past Medicare's locum limit. You can hire multiple substitute physicians to cover the physician's absence. Hire each physician to cover only the maximum allowable period of 60 days, then move on to the next substitute.

Scenario 2: You hire two locum tenens physicians to replace the anesthesiologist (one to handle anesthesia services and the other for pain management services). Keep records of each patient (both anesthesia and pain management) seen by each of the locum physicians. For practical purposes, you might be able to run a concise report showing all cases reported for the time period using modifier Q6. Identify both the anesthesia and pain management physicians by NPI, and keep the information with your documentation. Although it may appear that only one physician is providing services (and therefore overlapping pain and anesthesia procedures), documentation will support the locum tenens arrangement in place.