When you hire locum tenens physicians, it’s important to understand how to bill for them so you’re not leaving money on the table. Whether you’re using supplemental or replacement physician services, we can provide answers to your billing questions.
Know the difference between replacement and supplemental services
Replacement services are used when your regular physician is unavailable to provide services, typically for 60 days or less. Supplemental services are used when you’re growing your practice and need a physician in addition to your current staff.
Due to Medicare restrictions, you will typically follow the same procedure as when supplemental services are needed if you need a replacement provider for more than 60 days.
Billing for supplemental physician services
Enroll your temporary physicians using the standard Medicaid and private payer process required by your state and insurance carrier. Note: Billing for Medicaid and private payers varies from state to state and carrier to carrier, so be sure you check with individual vendors if you have questions.
Section 30.2.7 of the Medicare Claims Processing Manual covers billing for supplemental physician services. It allows a carrier to make payments to your group for services performed by a supplemental physician with a contractual agreement to see your patients. However, the entity receiving payment and the physician are jointly responsible for any Medicare overpayment.
Additionally, the physician has unrestricted access to claims submitted by an entity for services he or she provided. When using services performed under a contractual arrangement, the supplemental provider will complete the necessary applications to bill for services with each of your private carriers and the Medicaid program for your state.
You also need to have your locum tenens physician complete a Medicaid and private career application and Medicare form 855R.
Billing for replacement physician services
If your locum tenens physician will work more than 60 days, you should begin the standard enrollment process early. However, you can bill Medicare with code modifier Q6 on the CMS 1500 section 24D for up to 60 days and should do so for doctors who work less than 60 days.
There is a chance Medicaid and private payers may still require standard enrollment, so check your state and insurance carrier guidelines to be sure.
Section 30.2.11 of the Medicare Claims Processing Manual covers billing for locum tenens services. It allows a practice to bill for temporary physician services during a regular physician’s absence. The regular physician must arrange coverage for no longer than 60 continuous days and then enter HCPCS code modifier Q6 after the procedure code during the billing process.
As with section 30.2.7, the entity receiving payment and the physician that provided the service are jointly responsible for any Medicaid overpayment, and the physician has unrestricted access to claims for his services.
Check out the infographic below for a visual look at billing for both supplemental and replacement physician services or download the PDF.