Locum tenens, or reciprocal billing arrangements, present challenges when it comes to billing and reimbursement. We have compiled a list of the top 10 questions and answers to help clarify this process. Read on to gain a comprehensive understanding of the guidelines and requirements for accurate coding and billing in locum tenens scenarios.

Q1: What does locum tenens mean, and how does it impact billing and reimbursement? 
A1: The Latin phrase “locum tenens” refers to the practice of hiring substitute physicians to fill in for regular physicians during their absence. It allows the regular physician to bill and receive payment for the substitute physician's services as if they provided the care themselves.

Q2: When should modifier -Q5 be used in locum tenens billing? 
A2: Modifier -Q5 should be used when locum tenens physicians have their own practice.

Q3: When should modifier -Q6 be used in locum tenens billing? 
A3: Modifier -Q6 should be used when a locum tenens physician does not have a separate practice.

Q4: Do locum tenens physicians bill Medicare directly? 
A4: Locum tenens physicians do not directly bill Medicare. Payment for Medicare-covered services is made in the name and billing number of the medical group that employed the locum tenens physician.

Q5: Can post-operative visits be billed separately in locum tenens arrangements? 
A5: No. Post-operative visits should not be billed separately since the medical group has already received the global fee for the procedure.

Q6: Are newly hired physicians without credentials considered locum tenens? 
A6: No. Newly hired physicians who are not yet credentialed do not fall under the locum tenens category. Patients should be scheduled with physicians within the practice who are credentialed with their insurance, and billing should be conducted using their own National Provider Identifier (NPI).

Q7: Do the billing requirements differ for non-Medicare payers in locum tenens arrangements? 
A7: Yes. The billing requirements may vary for non-Medicare payers. It is important to verify whether they recognize locum tenens arrangements and if any payer specific paperwork or in-network status is required.

Q8: How should I bill for a locum tenens physician providing services in a temporary capacity?
A8: Utilize the appropriate modifier (-Q5 or -Q6) based on whether the locum tenens physician has their own practice or not, and ensure the billing is done through the employing medical group. 

Q9: How long may a locum tenens substitute for a physician?
A9: According to Medicare, locum tenens physicians are used in temporary situations of no more than 60 days where the practice physician cannot see patients. The time frame may also be unique to the payer, so verify with each payer.

Q10: Are there specific guidelines for billing when a practice hires a locum tenens physician for an extended period? 
A10: Yes. If a locum tenens physician is employed for an extended period, special considerations may apply. It is advisable to consult payer policies to ensure compliance with their guidelines.

Examples

Here are five case examples to help illustrate how these questions and answers apply to real-life situations. 
1. Retina specialist Dr. Johnson is on vacation for two weeks and arranges for Dr. Smith, a locum tenens physician without a practice, to provide eye care services to Dr. Johnson’s patients at the practice during that time. 
Billing Modifier: Use -Q6 because the service was furnished by a substitute physician under a reciprocal billing arrangement.

2. Dr. Singh, a comprehensive ophthalmologist, hires a new associate, Dr. Patel, who has not yet been credentialed with insurance payers. Dr. Patel sees patients at the practice while going through the credentialing process. 
Billing Modifier: Since Dr. Patel is not a locum tenens physician and is a new associate, do not use either of the locum tenens modifiers. The billing should be done under Dr. Patel's own NPI and once the credentialing process is complete.

3. Dr. Garcia is on maternity leave for three months. Dr. Rodriguez, a physician who works part time with another local practice, is hired to cover her patient load during her absence.
Billing Modifier: Use -Q5 since the service was furnished by a substitute physician under a reciprocal billing arrangement with the practice.

4. Dr. Lee needs to attend a medical conference for four days. Dr. White is contracted to provide eye care services at Dr. Lee's clinic during that period. Dr. White sold a practice and was getting ready to retire. 
Billing Modifier: Use -Q5 because the service furnished by a substitute physician without a separate practice under a reciprocal billing arrangement.

5. Dr. Nguyen, a pediatric ophthalmologist, hires Dr. Wang, a newly graduated and credentialed pediatric ophthalmologist without a separate practice on a long-term basis to establish his own practice within Dr. Mitchell's clinic. 
Billing Modifier: In this scenario, Dr. Wang is not acting as a substitute or temporary physician, but rather establishing his own practice within the clinic. Do not use either of the locum tenens modifiers since it would not be appropriate. Dr. Wang should bill under his own NPI as a separate practicing physician.

Navigating the intricacies of locum tenens billing and reimbursement is essential for accurate and compliant coding and billing practices. Always refer to payer policies and guidelines for specific information and ensure compliance with the appropriate modifiers and documentation requirements to streamline the billing and reimbursement process.