Billing and Service Guidelines

It is a common practice for hospitals and other healthcare facilities to use locum tenens physicians to fill in for staff physicians who are on vacation or unavailable because of illness. But these organizations often don’t bill for locum tenens because they don’t feel it’s worth the effort, or it’s just too complicated.

Unfortunately, employers may not be aware of how much money they are leaving on the table by not billing for locum tenens services – some estimates put the amount lost at more than $250 million. However, the fees collected for locum tenens services offset or cover the costs; so using locum tenens physicians allows providers to maintain revenue, while preventing the loss of patients and protecting present and future revenue.

The facility can bill for the services of the locum tenens for up to 60 days. If the locum tenens works longer than that amount of time, he or she must be credentialed and enrolled similar to a new physician,

Each service provided by the locum tenens has to be recorded, along with the physician’s identification number. A Medicare claim has to include the Q6 modifier in box 24D of the CMS-1500 form. The Q6 modifier shows that a locum tenens physician performed the services. The regular physician’s provider identification number is placed in box 24J.

Most of the state Medicaid plans use the same guidelines as CMS. But providers should check with the applicable state’s Medicaid plan for guidance.

If providers are dealing with contract payers, such as HMOs or PPOs, they should check the contract to find out how to make a claim for locum tenens services. Most payers allow providers to bill for locum tenens under the regular physician’s name and NPI.

Please note that some payers require providers to credential the locum tenens before billing; the provider has to bill under the name of the locum tenens. The time for credentialing a locum tenens varies; although sometimes it is a short process, if the insurance company is responsible for credentialing, allow 30 to 60 days.

For commercial insurance carriers, providers can generally bill for locum tenens services under the regular physician’s NPI. They normally do not require credentialing.

If your hospital or healthcare facility is looking to add to its full-time staff or needs locum tenens, we’ll find the physicians with the skills and experience you need. Contact us today.