Date: Sunday, March 1, 2020 Locum tenens is the term for a system now in place under Medicare that allows a PT to bring in another licensed physical therapist to treat Medicare patients and bill Medicare through the practice provider number during temporary absences for illness, pregnancy, vacation, or continuing medical education.
Can a locum tenens doctor bill Medicare?
Billing for Locum Tenens Locum tenens physicians may not bill Medicare; they should be paid on a per diem or similar fee-for-time basis. Claims payment is made under the name and billing number of the physician or the practice (in the event the physician has left the practice) that hired the locum tenens physician.
How do locum tenens agencies help hospitals?
Hospitals and other healthcare facilities reach out to locum tenens agencies when they need help finding temporary coverage. Locums agencies then turn to their network of healthcare professionals to find the right match between the provider and the facility.
What is the new locum tenens policy for CMS?
CMS Updates Locum Tenens Policy. The policy covers both informal and reciprocal, or per diem or other fee-for-service compensation for such services. In the past, the term “locum tenens” was used to identify the paid services, and “reciprocal” identified a billing arrangement between covering physicians.
How do I bill locum tenens for Medicare?
Billing for Locum Tenens Locum tenens physicians may not bill Medicare; they should be paid on a per diem or similar fee-for-time basis. Claims payment is made under the name and billing number of the physician or the practice (in the event the physician has left the practice) that hired the locum tenens physician.
Do you get benefits with locum tenens?
Locums providers often make a higher hourly rate than permanent full-time hospital-employed clinicians. As a locum tenens provider, you're taxed as an independent contractor or a corporation and many of your expenses can be written off. Regardless of where you are in your career, you'll reap the benefits.
What are the rules for locum tenens?
The regular physician cannot bill for the services of a locum tenens physician for a continuous period of longer than 60 calendar days. If, after returning to work for a brief period of time, the regular physician must be absent again, the same locum tenens physician may be re-hired and a new 60-day period begins.
What modifier is used for locum tenens?
Q6 modifierThe Q6 modifier is intended to be a tool that practices can use when a physician is away for an extended period of time, therefore requiring temporary coverage by a locum tenens.
What are benefits in working as locum?
We've outlined the top five advantages locums get to enjoy.Career Flexibility. A career as a locum doctor offers exceptional personal and work-life balance. ... Personal and Financial Fulfilment. ... Gain Career Experience. ... Travel Opportunities. ... Plenty of Employment Opportunities.
Do locum doctors get benefits?
Locum tenens physicians have to pay their own taxes and pay for their own benefits. The hospital or healthcare group you work with will not provide the benefits that they provide traditional employees.
How are locum tenens billed?
The locum tenens physician's services must be billed using the modifier Q6 to show that a locum tenens physician provided care, and a record of the services provided to your patients by the locum tenens physician must be kept on file.
What is Q6 modifier Medicare?
Q6 modifier is used for locum physicians. These physicians give services only when the concerned physician is absent or on a long vacation leave. For Medicare, you bill for locum physician using Q6 modifier if the regular physician is not available or absent.
What is the time limit for billing locum tenens?
60 daysBoth the law at section 1842(b)(6)(D)(iii) of the Social Security Act and the manual instructions cited above state that the services of the substitute physician are not to be provided over a continuous period of longer than 60 days.
What is the difference between modifier Q5 and Q6?
Use Q5 when there is a reciprocal billing arrangement and use Q6 when there is a fee-for-time compensation arrangement. Medicare has some specific rules about the time involved so be aware of individual payer policies and their time requirements.
Is Q6 a payment modifier?
Submit HCPCS modifier Q6 to indicate that services were provided under a Fee-For-Service Time Compensation arrangement. The regular physician generally pays the substitute physician a fixed per diem amount.
What is the difference between a locum tenens physician and a member of the medical staff?
In the healthcare domain, a locum tenens refers to a substitute physician hired to take over a regular physician's professional practice when the regular physician is absent for reasons such as illness, vacation, pregnancy, or continuing medical education.
What is a locum tenens physician?
The regular physician generally pays the substitute physician a fixed amount per diem, with the substitute physician having the status of an independent contractor rather than of an employee. These substitute physicians are generally called “locum tenens” physicians.
What is a locum tenens billing arrangement?
A locum tenens billing arrangement is intended to promote the continuation of the billing process for regular, but absent, physicians and their cooperation in helping the locum tenens to complete ...
What is the Q6 modifier on a Medicare claim?
Medicare requires claims for services provided by a locum tenens physician to include the Q6 modifier, which designates services were performed by a locum tenens physician, in box 24D of the CMS-1500 form.
How long can you have locum tenens?
They may not to exceed sixty (60) consecutive days. Terms like ongoing or current will not be accepted. If the services are anticipated to exceed sixty (60) days, then a regular provider number application must be made concurrent with the locum tenens.
Why do doctors retain substitute physicians?
A. Background. It is a longstanding and widespread practice for physicians to retain substitute physicians to take over their professional practices when the regular physicians are absent for reasons such as illness, pregnancy, vacation, or continuing medical education, and for the regular physician to bill and receive payment for ...
Is a locum tenens physician considered an independent physician?
Physicians who are members of a group but who bill in their own names are generally treated as independent physicians for purposes of applying the requirements of subsection A for payment for locum tenens physician services. Compensation paid by the group to the locum tenens physician is considered paid by the regular physician for purposes ...
Can you use a signature stamp on a locum tenens?
An ORIGINAL SIGNATURE of the locum tenens physician is required, a signature stamp may not be used, nor can others sign for this physician. Failure to complete and have a valid original signature on the form in its entirety may result in Medicaid claims not processing timely and completely.
How to apply for locum tenens?
For Medicare eligibility and reimbursement, specific criteria must be met for a legitimate locum tenens, or fee-for-time compensation arrangement: 1 The substitute provider can only bill under the regular provider’s National Provider Identifier, or NPI, number for 60 continuous calendar days, unless the regular physician was called to active military duty. 2 The patients must seek the services of the regular physician. 3 Claims submitted to Medicare must use the modifier “Q5” or “Q6,” as appropriate, to indicate the use of a locum tenens. 4 The substitute physician must not be an employee, but an independent contractor. 5 The substitute physician must be paid on a per diem or similar time basis.
How long can a substitute provider bill?
The substitute provider can only bill under the regular provider’s National Provider Identifier, or NPI, number for 60 continuous calendar days, unless the regular physician was called to active military duty. The patients must seek the services of the regular physician.
Can a physician bill under a physician's name?
If a physician dies, no one can bill under that physician’s name. Locum tenens arrangements for Medicare do not include nurse practitioners, physician assistants or any other provider type besides physician and physical therapist (in certain geographies or region). However, they do not need to be of the same specialty.
Can a substitute physician be a fee for time?
A fee-for-time arrangement would not qualify, since there is no regular physician to substitute for. The regular physician cannot provide services elsewhere while a substitute physician also is billing under her credentials; the regular physician cannot be available to work.
Can a pediatrician be reimbursed by Medicare?
During that time, a physician from a staffing agency sees that physician’s patients. Those visits can be billed to Medicare under the regular physician’s name, and Medicare will reimburse the regular physician as if she performed the services. A pediatrician leaves the medical group.
Can a new hire bill as a locum tenens provider?
However, they do not need to be of the same specialty. A newly hired physician cannot bill as a locum tenens provider while pending Medicare enrollment; employees do not qualify. You are expanding your practice and need additional providers.
How long can a locum tenens be on Medicare?
Medicare beneficiaries must seek to receive services from the regular physician, and services may not be provided by the locum tenens over a continuous period of more than 60 days (with the exception of a locum tenens filling in for a physician who is a member of the armed forces called to active duty).
What does locum tenens mean?
Locum tenens is a Latin phrase that means “ (one) holding a place.”. In the medical field, locum tenens are contracted physicians who substitute for a physician who has left the practice, or who is temporarily unavailable (e.g., on medical leave, on vacation, etc.). The Centers for Medicare & Medicaid Services ...
Is a nurse practitioner billed under locum tenens?
In other words, services provided by non-physician practitioners (e.g., nurse practitioners and physician assistants) may not be billed under the locum tenens provision.
Do locum tenens have to be enrolled in Medicare?
The locum tenens physician does not have to be enrolled in the Medicare program or be in the same specialty as the physician for whom he or she is filling in, but the locum tenens must have a National Provider Identifier (NPI) and possess an unrestricted license in the state in which he or she is practicing.
Why do doctors work locum tenens?
Because assignments can be as short as a few days — or even a few shifts — physicians will often work locum tenens in addition to a full-time job to earn extra money on the side. Some locum tenens assignments require travel, others are available close to home.
What is locum tenens?
Medical insurance and benefits – Locum tenens providers are responsible to fund their own benefits, including health and life insurance or retirement plans. This isn’t an issue for providers working locum tenens in addition to a permanent position.
How much does a locum tenens make?
According to recent data from CHG Healthcare, on average across all specialties, physicians who work locum tenens full-time make $32.45 per hour more than permanent-only doctors.
What are the benefits of working with locum tenens?
One of the biggest benefits of working with locum tenens recruiters is their ability to negotiate on your behalf. That includes pay enhancers like per diem payments, mileage reimbursement, and shift premiums. Most importantly, a good recruiter will get to know you.
What is patient load?
Skill set and patient load – Positions that include difficult procedures or require specialized skills often pay more than general assignments. Patient load also plays a role in pay — slower-paced assignments tend to pay less than high workload positions.
Does locum tenens pay state taxes?
Also, a locum tenens physician will generally be subject to income taxes in each of the states they work assignments. Fortunately, a state tax credit for the nonresident state tax liability is generally available to reduce the home state tax (state of residence generally taxes all income).
What is locum tenens?
Locum Tenens – The Role of and Billing for the Substitute Provider. If your physician needs a break because of COVID-19, a family vacation or to take time off for a new addition to the family, Locum Tenens is the concept of substituting for your physician with another physician.
Did Medicare change the Locum Tenens?
Medicare made major changes to the Locum Tenens section of the Manual in the last couple of years. Understanding those changes and the sometimes complex billing and documentation requirements for Medicare patients is a start.
Who pays locum tenens?
The group’s payment to the locum tenens physician is considered paid by the regular physician (the group pays the locum tenens physician on behalf of the regular physician).
Why do doctors retain substitute physicians?
It is a longstanding and widespread practice for physicians to retain substitute physicians to take over their professional practices when the regular physicians are absent for reasons such as: Illness
How long can a substitute physician work?
Without this flexibility, a regular physician could only use a single substitute physician for a period no longer than 60 continuous days. Anytime following the 60 days would require a different substitute or that the physician return to work for at least one day, which would reset the continuous time period.
When do you add CR modifier to a claim?
This update clarified that, if a provider utilizes a substitute physician for longer than 60 continuous days, they must add the CR modifier to claims starting on the 61 st day and beyond.