Summer is in full swing and we all want to take a vacation for a couple of weeks — for most of us, a well-deserved and much-needed break. Unfortunately, for those of us in solo practice, this is almost an impossible dream since we have no partners to cover us and keep our practices running and to ensure that our patients are seen.
Or, what if we needed to take off some time due to health problems? Would our practices be able to stay open if we needed to take time off?
Taking time off from the office may be a possibility. Actually, taking time off really is not the end of the world and the practice may go on without us.
Have you ever heard of a locum tenens — or substitute physician? Of course, we all know that accreditation by third-party payers for a new physician can be a dreaded process, and we may think it certainly is not worth the hassle to hire a temporary physician just for a couple of weeks.
Thankfully, you don’t have to go through the accreditation process for a locum tenens. It is legal to bill for a substitute physician under your provider number.
Let’s take a look at the conditions and billing requirements for a locum tenens.
Hiring a Locum Tenens
The locum tenens usually comes from out of town to cover your practice. The locum tenens is considered an independent contractor but not an employee, and most of the time you can hire one through an agency — you pay the agency directly and the agency reimburses the locum tenens. Therefore you don’t have to provide any benefits such as health insurance, vacation, etc.
The regular physician can bill Medicare for the locum tenens physician under his/her provider number. It is important to understand that the regular physician can not work at the same time. The regular physician identifies these services provided by locum tenens with modifier Q after each CPT code.
Another important point to keep in mind is that this arrangement can not go on for more than a continuous period of 60 days. This continuous 60-day period even includes days when the substitute physician does not see patients.
Example I: The regular physician goes on vacation on June 30, and returns to work September 4. A substitute physician provides services to Medicare part B patients of the regular physician on July 2 and at various times thereafter, including August 30 and September 2. The continuous period of covered visit services begins on July 2 and runs through September 2, a period of 63 days. Since the September 2 services are furnished after the expiration of 60 days of the period, the regular physician is not entitled to bill and receive direct payment for them. The substitute physician must bill for these services in his/her own name. The regular physician may, however, bill and receive payment for the services that the substitute physician provides on his or her behalf in the period from July 2 through August 30.
This arrangement should not be implemented for a physician who will be hired permanently. Even though this process is legal and well recognized by Medicare and Medicaid carriers, not all private third-party payers will approve it. Therefore, it is important to check with each of your contracted carriers to make sure that they approve and will pay for your locum tenens.
Example II: You would like to take off holidays including Thanksgiving, Christmas and for the New Year to go on a ski trip in January. If you take off beginning on November 15 and the locum tenens starts working November 15 and you want him or her to work only 3 days a week through February 1, you will not be able to bill for this locum tenens arrangement after January 15 because November 15 through January 15 is a continuous 60 days, despite the fact that he or she did not work a total of 60 days during that time.
However, there are no rules on how often you can have a locum tenens arrangement as long as you come back and work after each 60 day period, after which you can restart the locum tenens arrangement again.
Continued Coverage for Patients
Armed with this information, it now may be possible to take a break — for vacation, sick time or any personal matter — and still have the coverage to keep your practice up and running, even if you work solo. Be sure to follow the rules regarding the 60-day continuous coverage period, and check with third-party providers to be sure they approve and will pay for a locum tenens.
Summer is in full swing and we all want to take a vacation for a couple of weeks — for most of us, a well-deserved and much-needed break. Unfortunately, for those of us in solo practice, this is almost an impossible dream since we have no partners to cover us and keep our practices running and to ensure that our patients are seen.
Or, what if we needed to take off some time due to health problems? Would our practices be able to stay open if we needed to take time off?
Taking time off from the office may be a possibility. Actually, taking time off really is not the end of the world and the practice may go on without us.
Have you ever heard of a locum tenens — or substitute physician? Of course, we all know that accreditation by third-party payers for a new physician can be a dreaded process, and we may think it certainly is not worth the hassle to hire a temporary physician just for a couple of weeks.
Thankfully, you don’t have to go through the accreditation process for a locum tenens. It is legal to bill for a substitute physician under your provider number.
Let’s take a look at the conditions and billing requirements for a locum tenens.
Hiring a Locum Tenens
The locum tenens usually comes from out of town to cover your practice. The locum tenens is considered an independent contractor but not an employee, and most of the time you can hire one through an agency — you pay the agency directly and the agency reimburses the locum tenens. Therefore you don’t have to provide any benefits such as health insurance, vacation, etc.
The regular physician can bill Medicare for the locum tenens physician under his/her provider number. It is important to understand that the regular physician can not work at the same time. The regular physician identifies these services provided by locum tenens with modifier Q after each CPT code.
Another important point to keep in mind is that this arrangement can not go on for more than a continuous period of 60 days. This continuous 60-day period even includes days when the substitute physician does not see patients.
Example I: The regular physician goes on vacation on June 30, and returns to work September 4. A substitute physician provides services to Medicare part B patients of the regular physician on July 2 and at various times thereafter, including August 30 and September 2. The continuous period of covered visit services begins on July 2 and runs through September 2, a period of 63 days. Since the September 2 services are furnished after the expiration of 60 days of the period, the regular physician is not entitled to bill and receive direct payment for them. The substitute physician must bill for these services in his/her own name. The regular physician may, however, bill and receive payment for the services that the substitute physician provides on his or her behalf in the period from July 2 through August 30.
This arrangement should not be implemented for a physician who will be hired permanently. Even though this process is legal and well recognized by Medicare and Medicaid carriers, not all private third-party payers will approve it. Therefore, it is important to check with each of your contracted carriers to make sure that they approve and will pay for your locum tenens.
Example II: You would like to take off holidays including Thanksgiving, Christmas and for the New Year to go on a ski trip in January. If you take off beginning on November 15 and the locum tenens starts working November 15 and you want him or her to work only 3 days a week through February 1, you will not be able to bill for this locum tenens arrangement after January 15 because November 15 through January 15 is a continuous 60 days, despite the fact that he or she did not work a total of 60 days during that time.
However, there are no rules on how often you can have a locum tenens arrangement as long as you come back and work after each 60 day period, after which you can restart the locum tenens arrangement again.
Continued Coverage for Patients
Armed with this information, it now may be possible to take a break — for vacation, sick time or any personal matter — and still have the coverage to keep your practice up and running, even if you work solo. Be sure to follow the rules regarding the 60-day continuous coverage period, and check with third-party providers to be sure they approve and will pay for a locum tenens.
Summer is in full swing and we all want to take a vacation for a couple of weeks — for most of us, a well-deserved and much-needed break. Unfortunately, for those of us in solo practice, this is almost an impossible dream since we have no partners to cover us and keep our practices running and to ensure that our patients are seen.
Or, what if we needed to take off some time due to health problems? Would our practices be able to stay open if we needed to take time off?
Taking time off from the office may be a possibility. Actually, taking time off really is not the end of the world and the practice may go on without us.
Have you ever heard of a locum tenens — or substitute physician? Of course, we all know that accreditation by third-party payers for a new physician can be a dreaded process, and we may think it certainly is not worth the hassle to hire a temporary physician just for a couple of weeks.
Thankfully, you don’t have to go through the accreditation process for a locum tenens. It is legal to bill for a substitute physician under your provider number.
Let’s take a look at the conditions and billing requirements for a locum tenens.
Hiring a Locum Tenens
The locum tenens usually comes from out of town to cover your practice. The locum tenens is considered an independent contractor but not an employee, and most of the time you can hire one through an agency — you pay the agency directly and the agency reimburses the locum tenens. Therefore you don’t have to provide any benefits such as health insurance, vacation, etc.
The regular physician can bill Medicare for the locum tenens physician under his/her provider number. It is important to understand that the regular physician can not work at the same time. The regular physician identifies these services provided by locum tenens with modifier Q after each CPT code.
Another important point to keep in mind is that this arrangement can not go on for more than a continuous period of 60 days. This continuous 60-day period even includes days when the substitute physician does not see patients.
Example I: The regular physician goes on vacation on June 30, and returns to work September 4. A substitute physician provides services to Medicare part B patients of the regular physician on July 2 and at various times thereafter, including August 30 and September 2. The continuous period of covered visit services begins on July 2 and runs through September 2, a period of 63 days. Since the September 2 services are furnished after the expiration of 60 days of the period, the regular physician is not entitled to bill and receive direct payment for them. The substitute physician must bill for these services in his/her own name. The regular physician may, however, bill and receive payment for the services that the substitute physician provides on his or her behalf in the period from July 2 through August 30.
This arrangement should not be implemented for a physician who will be hired permanently. Even though this process is legal and well recognized by Medicare and Medicaid carriers, not all private third-party payers will approve it. Therefore, it is important to check with each of your contracted carriers to make sure that they approve and will pay for your locum tenens.
Example II: You would like to take off holidays including Thanksgiving, Christmas and for the New Year to go on a ski trip in January. If you take off beginning on November 15 and the locum tenens starts working November 15 and you want him or her to work only 3 days a week through February 1, you will not be able to bill for this locum tenens arrangement after January 15 because November 15 through January 15 is a continuous 60 days, despite the fact that he or she did not work a total of 60 days during that time.
However, there are no rules on how often you can have a locum tenens arrangement as long as you come back and work after each 60 day period, after which you can restart the locum tenens arrangement again.
Continued Coverage for Patients
Armed with this information, it now may be possible to take a break — for vacation, sick time or any personal matter — and still have the coverage to keep your practice up and running, even if you work solo. Be sure to follow the rules regarding the 60-day continuous coverage period, and check with third-party providers to be sure they approve and will pay for a locum tenens.
