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  • Billing Exams Without Insurance Credentialing

    Question: We have a new physician joining our practice sooner than her license is available and prior to credentialing. Can we bill under the group with a specific modifier? I heard about locum tenens.

    Updated May 2022
    Answer: Hiring a new physician does not qualify for locum tenens. Locum tenens physicians are used in temporary situations of no more than 60 days where the physician of the practice cannot see patients.  It is also not appropriate to bill under the senior partner’s NPI. Ensure you allow adequate time and follow all steps to properly credential new physicians. If the new physician is not yet credentialed, you can schedule the patient with another physician in the practice that is participating. This ensures proper payment and no reason for payers to recoup in the future.  

    Learn more about exam billing in Fundamentals of Ophthalmic Coding