Practice Management Alert

Don't forget to append modifier Q6

When one of your physicians takes a vacation or a leave of absence, billing staff needs to know how to file claims for locum tenens physicians, or Medicare will likely deny any claims for the substitute physician's services.

Follow this expert advice, and you won't miss a beat when you-re billing for the substitute physician.

Put Q6 on Locum Tenens Claims

In order for the regular physician to bill and receive payment for the substitute physician's services, he must observe the tenants of locum tenens billing, says Jean Acevedo, LHRM, CPC, CHC, senior consultant with Acevedo Consulting Inc. in Delray Beach, Fla.

The most important thing to remember when billing for locum tenens doctors is modifier Q6 (Service furnished by a locum tenens physician), which you must append to every procedure code on a claim for a locum tenens physician.

Q6 Quells Confusion When Regular Doctor's Out

Medicare requires modifier Q6 on these services because it shows that someone filled in for the regular doctor. -The regular physician identifies the services as -substitute physician services meeting the Medicare requirements- by adding modifier Q6 to each procedure code,- Acevedo says.

Example: The sole gastroenterologist in a one-physician practice goes on vacation for two weeks, and gets a locum tenens physician to take her place. One day, the locum tenens gastroenterologist performs a level-two E/M service on an established patient with persistent nausea and heartburn.

Since a locum tenens physician provided the service, -the bill goes out under the regular doctor's name, with a Q6 modifier on the procedure code even though the regular doctor was out of town,- says Barbara Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Tinton Falls, N.J., and member of the National Advisory Board for the American Academy of Professional Coders.
 
On the claim, you should:

- report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) for the E/M service.

- append modifier Q6 to 99212 to show that a locum tenens physician performed the service.

Check With Non-Medicare Payers First

Before using modifier Q6 on a non-Medicare claim, check with the carrier, Cobuzzi says.

Some carriers will follow the Medicare guidelines for locum tenens, but -this is an area where it is not safe to assume that an insurer follows Medicare guidelines. Contracted plans have very specific guidelines as to what a contracted physician is to do if she requires a covering physician,- Acevedo says.

Many private insurers will require -that the temporary physician also be a credentialed provider with the plan. When having a locum tenens physician fill in for a physician who is unavailable for some reason, each contracted non-Medicare plan contract should be reviewed,-  Acevedo says.

Locum Tenens Status Ends at 60 Days

Remember that locum tenens physicians cannot fill in at a practice for more than 60 consecutive days. Once he or she has worked 60 straight days, -the substitute physician must bill for these services in his own name,- Cobuzzi says.

Try this: If a locum tenens physician has reached his 60-day deadline and you still require his services, -have the physician complete the CMS 855R form, reassigning the temporary physician's Medicare benefits to the practice,- Cobuzzi says.

-Once the reassignment of benefits has been processed by the local carrier, the practice can then bill for the temporary physician's services under the practice's group number,- she says.