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Locum Tenens - Applying it Correctly

Author: John R. Outlaw, CHC, CHBME
Posted: 12 December 2012
Copyright: (c) 2012, PathologyOutlines.com, Inc.

There are two important concepts to understand about locum tenens to understand how to apply it. The first is that the term itself means a "place holder" or someone who fills a role in the absence of someone else. The Latin term actually means "lieutenant" - not as a military rank but in the broader sense of doing the work of someone else or "in lieu of" someone else when the other person is not available to do it himself (e.g., "The president had one of his lieutenants attend the luncheon for him"). The second is that by the very nature of the job, it is understood to be temporary, and Medicare caps the period of time that one physician may be contracted to "fill in" for another physician under the locums tenens rules at 60 days. For our purposes then, a locums tenens provider must ALWAYS be filling in for another provider who is out of the office and unable to perform his/her duties on a particular day (e.g., out sick, on vacation, away on business, etc.), and the work of a locums tenens provider may only be billed under the locums tenens rule for 60 days. By the 61st day, the substitute physician must either be enrolled as a member of the group or begin billing for the work he/she performs in his own right (under his/her own NPI).

The Medicare rules regarding billing for the services of a locum tenens physician can be found in the Medicare Claims Processing Manual at Chapter 1, Section 30.2.11, click here.

To bill for the services of a substitute physician under Medicare's locum tenens rule without enrolling that physician as a member of the group, ALL of the following criteria must be met:

1. The regular physician must be unavailable to provide the services (i.e., sick, vacation, business travel, etc.).
2. The locum tenens physician must be compensated on a per diem or similar fee-for-time basis.
3. The regular physician or group (as the case may be) cannot bill for the services of a locum tenens physician for a continuous period of longer than sixty (60) days.
4. All claims submitted for services provided by the locum tenens physician while the regular physician is unavailable must include the "Q6" modifier to indicate that a substitute physician provided the services.

Note that the 60 days is a "consecutive" 60 day period. Therefore, a locum tenens physician providing coverage three days a week beginning on September 1 can still only provide services for the same absentee physician through October 30. This also applies even if several different locum tenens physicians are used to provide coverage during the 60-day period, because the limitation is tied to the billing of the Q6 modifier, not to the number of days that any particular locum tenens physician provides coverage. Therefore, a new sixty (60) day period for billing the services of a locums tenens physician does not commence as a result of a break in service of the substitute or locum tenens physician - but only by a break in the absence of the physician for whom a substitute physician is necessary. After the regular physician returns to work and provides services for at least one day, then a locum tenens physician can provide services as a substitute for that regular physician again at some point in the future, if necessary, for up to sixty (60) consecutive days.

Medicare also permits a group practice to bill for services of a substitute physician who is contracted to fill in after a physician has left the group practice by applying the locum tenens policy while the new physician is being enrolled/credentialed by Medicare; that is, the group may bill for services of a substitute physician under the regular physician's NPI, even after the regular physician has left the group. However, whatever the circumstances, at the end of 60 consecutive days, the services provided by the substitute or locums tenens physician may no longer be billed using the regular physician's NPI with a Q6 modifier; beginning with the 61st day, the services provided by the substitute or locums tenens physician must be billed under his/her own NPI.

Finally, it is important to note that because the services provided by a locums tenens physician must be connected to the absence of a regular physician, these rules do not support the use of a contracted physician to provide part-time or "temp" services for any reason unrelated to the absence of a regular physician for whom the contracted physician is "substituting". A physician who is contracted on a part-time basis for any purpose other than to fill in when the regular physician is out of the office and not performing services for a period of time must be enrolled as a member of the group and his/her services must be billed under his/her own NPI.

John R. Outlaw is the vice president for regulatory affairs and compliance for Pathology Service Associates, LLC (PSA) - a Med3000 company, and has more than 27 years of experience in healthcare claims administration. He is a member of the HBMA Board of Directors. John also chairs the HBMA's Ethics and Compliance Committee.

PSA, now part of McKesson, specializes in pathology and clinical laboratory billing, marketing, and business support services. For questions related to this topic or to learn more, please click here or contact Leigh Polk at 1-800-832-5270 ext. 2941 or Leigh.Polk@McKesson.com.