Wiki Death of Provider/Locum Tenens

[SFRISINA]

Our Health Plan has received a claim for a DOS of 3/20/14. The provider of services passed away on 1/12/14. The claim was flagged and sent to me in our compliance department.
I spoke with the provider's office and they stated that they are allowed to bill using Locum Tenens for 60 days as long as they are using the Q6 modifier. I have looked everywhere and, although I can find scenarios with doctors having Locum Tenen coverage while they are out of the office, I am unable to find any documentation that states what to do after the physician has passed away.
The provider's contract has obviously ended, so the claim was denied. My questions are:
1. How would the physician's office bill for these services?
2. Is it appropriate for them to be billing in this fashion?
3. Where is this in writing so I may present it to the physician's office and help them get their claim paid?

Thanks in advance!!

Stacy

 

[MarcusM]

Modifier Q6 Fact Sheet

Definition: Services furnished by a locum tenens physician
Appropriate Usage
When a physician agrees to see patients of another physician under arrangements of the original physician
The regular physician is not available to see patients
The patient arranges or seeks service of their regular physician
Short term coverage provided, under 60 days
The physician seeing the patient is not in practice for themselves, or employed as part of another practice
Inappropriate Usage
When the physician is covering for an absence of a long term
When the physician is in the same group
CMS Resources
CMS Internet Only Manual 100-04 Chapter 1 Section 30.2.11
http://www.cms.gov/manuals/downloads/clm104c01.pdfAdobe Portable Document Format

Note: The regular physician maintains the records, and states who saw the patient that day by name and National Provider Identifier (NPI).


Even if the office could bill like this, and I am having trouble on why the office would do this, 60 days would have ended around 3/15/14.