emilyj
New
Hi All,
First, I apologize if this is "Easy," but I'm new to medical billing/coding and I'm the only individual at my employer in the medical biller role currently (in process of hiring additional
). Any guidance/resources you all can offer will be GREATLY appreciated!
Here's the situation:
We have a physician who is currently not physically seeing patients from 1/1/22 - 6/1/22. After 6/1/22, the physician will return. In the meantime, I plan to bill locum tenens physician under "previous" physician NPI with Q6 modifier. My question is, I have to submit for prior authorization for a medication for a patient. The patient is technically new based on not having been seen for the past 3 years, but was previously seen by another physician employed here. The patient was recently seen by the locum tenens provider under the schedule of the physician who's out. Do I submit the prior authorization request under the locum tenens NPI or the NPI of the physician who's out?
To make it more confusing, the locum tenens physician has been talking/coordinating with our physician who is out and the physician who is out is taking call/on call while he's "out."
The Locum Tenens physician is credentialed with Medicare and Medicaid already, but working on credentialing with commercial payers yet.
Ultimately, my questions are:
1. Who's NPI do I submit Prior auth request under?
2. Can we even bill with Q6 modifier?? - does the fact that we are still communicating to physician who is "out" and him taking call make him available, or is him being physically absent count as him being unavailable?
Thank you!!
First, I apologize if this is "Easy," but I'm new to medical billing/coding and I'm the only individual at my employer in the medical biller role currently (in process of hiring additional
). Any guidance/resources you all can offer will be GREATLY appreciated!Here's the situation:
We have a physician who is currently not physically seeing patients from 1/1/22 - 6/1/22. After 6/1/22, the physician will return. In the meantime, I plan to bill locum tenens physician under "previous" physician NPI with Q6 modifier. My question is, I have to submit for prior authorization for a medication for a patient. The patient is technically new based on not having been seen for the past 3 years, but was previously seen by another physician employed here. The patient was recently seen by the locum tenens provider under the schedule of the physician who's out. Do I submit the prior authorization request under the locum tenens NPI or the NPI of the physician who's out?
To make it more confusing, the locum tenens physician has been talking/coordinating with our physician who is out and the physician who is out is taking call/on call while he's "out."
The Locum Tenens physician is credentialed with Medicare and Medicaid already, but working on credentialing with commercial payers yet.
Ultimately, my questions are:
1. Who's NPI do I submit Prior auth request under?
2. Can we even bill with Q6 modifier?? - does the fact that we are still communicating to physician who is "out" and him taking call make him available, or is him being physically absent count as him being unavailable?
Thank you!!