Practice Management Alert

Question: We have a temporary physician coming in for a couple of weeks to cover patient visits while some of our regular doctors take vacation time. The temp physician is not a part of our network. How do I bill for his services?

Florida Subscriber

Answer: You must abide by locums tenens rules for billing the services of the substitute physician, also referred to as a locum tenens physician, your practice is using.

With Medicare, billing for a locum tenens- services is fairly straightforward. You have to append modifier Q6 (Service furnished by a locum tenens physician) to all of the temporary doctor's claims, and bill under the NPI of the physician the locum is replacing. Also, you should include the temporary doctor's NPI in box 23 on the CMS-1500 billing form.

Pitfall: When you report locum tenens services, don't confuse modifier Q6 with reciprocal billing (modifier Q5, Service furnished by a substitute physician under a reciprocal billing arrangement). You use modifier Q5, for example, when your physician arranges with another doctor to cover each other's patients on weekends. In this situation, Doctor A will see Doctor B's patients and bill under Doctor B's NPI using modifier Q5. The physicians don't exchange any money because the services even out over time.

There are a number of instances in which your practice might employ a locum tenens physician. For example, you might need a substitute if one of your regular doctors:

- goes on vacation

- has an illness that requires extended recovery time

- goes on maternity or family health leave

- takes a leave in order to attend continuing medical education sessions.

Watch your timing: You can bill for a locum tenens physician for 60 continuous days. If the locum leaves your practice for a time and then comes back, the 60-day clock starts again.

Caveat: Locum tenens guidelines for commercial payers and state Medicaid (Title 19) programs can be very different. Because of these differences, check with your payers periodically to verify that their guidelines for locum tenens billing haven't changed since the last time you hired a substitute physician.

Non-Medicare payers: Not all non-Medicare payers recognize the Q6 modifier for a locum tenens physician's services. If this is the case, you need to find out in writing from each payer what its policy for billing out locum tenens services is. You never want to be accused of billing for services not provided by your provider when you had the best of intentions to do it correctly.