Locum Tenens In, Provider Out

December 8, 2010

How should this physician bill for a locum tenens provider?

Question: Some providers are permanently leaving our practice and we are exploring opportunities of employing locum tenens providers. If I understand correctly:

• The substituting physician should bill under the departing physician's NPI, with the substitute's NPI on file;

• If the substitute is a "hired gun," claims should have modifier Q6 appended;

•If the substitute has another practice (solo/group) - claims should include modifier Q5; and

•Billing could continue for 60 calendar days, but after that the remaining physicians should share the workload.

Answer: You essentially have it right except for maybe a couple of things.

I don't think you would ever use Q5. When they talk about reciprocal billing they mean that physician A covers physician B on weekends and the like and they basically cover one another's patients and bill in one another's name.

That's not what's happening here. One of your providers is gone. There can be no reciprocity in your current situation.

Use the Q6 when you hire someone from the outside - it has a shelf-life of 60 days.

After that, don't start swapping numbers around. A lot of people get way too creative after 60 days. Look at the Medicare guidance online for details on this.

Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or editor@physicianspractice.com.

This question originally appeared in the November 2010 issue of Physicians Practice.