Locum Tenens Billing
Scenario One: Billing for locum tenens coverage for an absent physician
If a physician is absent for a limited period of time for vacation, disability, continuing education, etc, you may bill Medicare for services performed by a locum tenens physician under the regular physician’s NPI as long as the following conditions are met.
• The regular physician must be unavailable.
• The locum must be compensated on a per diem or similar fee for time basis.
• The Medicare beneficiary seeks to receive the services from the regular physician.
• 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.
If a physician is absent longer than 60 days without returning to work, the locum tenens must be credentialed and enrolled as you would do if this were a new physician.
Scenario Two: Billing for locum tenens coverage for a vacancy
Medicare permits billing under the Q6 modifier on behalf of a physician who has left a practice for a period of no more than 60 days. The same rules apply as above.
Scenario Three: Billing for locums coverage for new growth or seasonal coverage
In the event that you must hire locum tenens physicians to cover seasonal and/or peak demand or while filling a vacancy created because you are growing your practice, all payers will require the locum physician to go through the normal credentialing and enrollment processes. Some locum tenens agencies, will assist with credentialing. You will need to complete all forms and submit them at least 60 days prior to the first working day of the locum physician to make sure the payers will reimburse the group or employer for their services.