Wiki MOD Q6 & Expanding Practice Coverage

[kitkatcoder]

Hello All,

Could use some guidance. Dr A provide services between 8am-5pm. Dr. B provides services between 5pm and 7pm. Can we bill Dr. B services as a Locum coverage with Modifier Q6 under Dr. A NPI.
Everything that I see is considered an expanding coverage service, but could use some assistance! As always your assistance is greatly appreciated.

Best Regards

 

[CBLENNIE]

The short answer is no. Per the CMS IOM 100-04 Medicare Claims Processing Manual Chapter 1 - General Billing Requirements section 30.2.11 Payment Under Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements), the regular physician (Dr. A in your scenario) retains a substitute physician (Dr. B in your scenario) to take over his/her practice when the physician is absent for a variety of reasons, but substitute physician cannot provide services to the regular physician's patients for no more than 60 days, excluding physicians who are on active duty in the military.

From the situation you've described Dr. A is not going to be temporarily absent from the practice and the intent in bring on Dr. B is that Dr. A doesn't want to treat their patients after normal office hours. Basically, Dr. B will be covering for Dr. A's patients from 5:00 PM - 7:00 PM on an ongoing basis. If this is the case then Dr. B would need to be credentialed with any payers, including Medicare, Medicaid and commercial insurance companies, and any services provided by Dr. B would need to be billed under Dr. B's NPI.

If there is something more going on here that wasn't included in your original post that may change my response please reply and I will try to answer any additional questions you may have.

 

[kitkatcoder]

The short answer is no. Per the CMS IOM 100-04 Medicare Claims Processing Manual Chapter 1 - General Billing Requirements section 30.2.11 Payment Under Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements), the regular physician (Dr. A in your scenario) retains a substitute physician (Dr. B in your scenario) to take over his/her practice when the physician is absent for a variety of reasons, but substitute physician cannot provide services to the regular physician's patients for no more than 60 days, excluding physicians who are on active duty in the military.

From the situation you've described Dr. A is not going to be temporarily absent from the practice and the intent in bring on Dr. B is that Dr. A doesn't want to treat their patients after normal office hours. Basically, Dr. B will be covering for Dr. A's patients from 5:00 PM - 7:00 PM on an ongoing basis. If this is the case then Dr. B would need to be credentialed with any payers, including Medicare, Medicaid and commercial insurance companies, and any services provided by Dr. B would need to be billed under Dr. B's NPI.

If there is something more going on here that wasn't included in your original post that may change my response please reply and I will try to answer any additional questions you may have.

Thank you!