The secret to getting reimbursed from federal and private payers for temporary physician coverage isn't such a secret after all.
With summer in full swing, it’s likely that you’re planning to take some time off, and with this decision often comes some operational and financial concerns. After all, your medical practice is a business; patients still need to be seen and bills paid regardless of your vacation plans.
Solving the first part is relatively easy: Just bring in a temporary physician to cover for you while you’re away. The second part can be a bit more complicated. First, you’re going to have to budget to pay for the coverage, and then deal with the fact that you will be missing out on revenue for every day that you’re away.
Wait a minute, hold the phone! If you’re used to thinking this way, it’s a good thing that you’re reading this post because it might just change your life. Or, at the very least, it may get you thinking more seriously about that trip to Aruba. Before I explain how, here’s a story that I want you to hear. (Hint: Don’t let this happen to you!)
A colleague of mine was telling me about a conversation he had with a practice owner who contracted with a physician to cover for his partner for a few months. A year later, this practice owner was referring back to the arrangement with some regret, saying he wished he could’ve captured even a small portion of the revenue that he would have with his partner during that time.
My colleague couldn’t believe his ears. "You mean you didn’t bill for the physician’s services?" he asked. Sadly, this practice owner had not. If only he had understood reimbursement rules of government and private insurance providers, he could have collected revenue for every service provided by this interim physician as if he was an actual staff employee.
In case you didn’t know, you can be reimbursed for temporary physician coverage. This is the whole concept behind locum tenens. Acting as independent contractors, these stand-in doctors specialize in covering for physicians who are absent. Essentially, they serve as a patient care contingency plan in the event a community’s regular caregiver becomes unavailable. When you take a leave of absence, you can feel at ease leaving previously scheduled patients in capable hands, and your practice should be reimbursed as if you had actually been there to perform the procedures yourself.
Reimbursement is possible regardless whether the payer is Medicare, Medicaid, or private insurance. If you can identify your payer mix and main insurance carriers, you can essentially sign up ahead of time to capture revenue for services performed in your office while you are contemplating your next move on the golf course.
Planning ahead is important because while Medicare and Medicaid will allow you to bill retroactively, some private insurance will not. So before you book that trip, get your staffing and reimbursement strategies in place. Navigating insurance manuals can be tricky, so here’s a whitepaper to serve as your roadmap.
I wish that the story I shared was just an anomaly, but it is not the first time that I've heard about a medical practice missing out on reimbursement. Hopefully, it will be the last.
As a practice owner, how familiar are you with filing claims for locum tenens coverage? Do you have any additional tips that we have not included here?