Wiki Locum Tenens for an NP

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dballard2004

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I hate to sound dumb here, but I have a question regarding a locum physician. Can a locum physician replace an NP who is gone for 10 days? Who do we bill under? The NP? Still use Q6?

I hope I don't sound too dumb here. Thanks.
 
For the purpose of Medicare, I would say no.

Palmetto: Services of nonphysician practitioners (e.g., CRNAs, NPs and PAs) may not be billed under the Locum Tenens or Reciprocal Billing reassignment exceptions. These provisions apply only to physicians.

http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/7REK6H0542

Trailblazers:These guidelines do not apply to providers other than physicians (i.e., Certified Registered Nurse Anesthetists (CRNAs), Physical Therapists (PTs), etc.).

http://www.trailblazerhealth.com/Publications/Training Manual/Locum Tenens.pdf

Although Chpt 1 of Medicare's Manual doesn't specifically exclude NPP, the citation(s) keeps referring to physicians.

30.2.11

http://www.cms.gov/manuals/downloads/clm104c01.pdf
 
Dawson,

I believe I misinterpreted your question the first time I read it. The information I provided applies when a NPP fills in for a physicians leave of absense which isn't allowed. I'm still unclear about a physician filling in for a NPP. I'm still doing some reseach on this. If someone doesn't reply before I find the answer (I hope), I'll post what I find.
 
Dawson,

I have personally contacted our Medicare medical director and have been speaking with him a good portion of the day and he states that a physician can not function as a locum for a NPP. Locum tenens guidelines only apply for provider to provider. He went on to say (in your example) that you could hire either a physician or NPP to do the work, as long as they are appropriately licensed in NC (this represents my state), enrolled in Medicare and using their own name/number to bill, or assigned to your group number, as appropriate. So to answer your question, it appears your example is not billable unless the above requirements are met.
 
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Thanks so very much for going above and beyond in this case! I will speak with my supervisor to see what our next step needs to be. I appreciate your help and I owe you one! Let me know when I can return the favor!
 
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