While locum tenens work offers incredible flexibility and rewarding experiences, navigating the billing process incorrectly or without the right support can quickly turn what should be an exciting opportunity into a stressful task.
But don’t worry—you are not alone in this! With the right guidance and a clear understanding of key concepts, locum tenens billing does not have to be a nightmare.
In this article, we will walk you through the basics, share essential tips, and highlight the steps you can take to simplify the process, ensuring that you get paid accurately and on time without unnecessary stress. Keep reading to discover everything you need to know to make billing as smooth as possible.
Table of Contents
- Locum Tenens Billing Basics
- Billing for Locum Tenens: Breaking It Down Into Two Categories
- Common Misunderstandings Regarding Locum Tenens Billing
- Tips and Key Points To Remember When Billing for Locum Tenens Positions
- Specifications and Required Documentation for Locum Tenens Physicians
- FAQs About Locum Tenens Billing
- Simplify the Locum Tenens Billing Process With Trusted Locum Staffing
Locum Tenens Billing Basics
Locum tenens physicians are typically paid on a per diem basis, and claims for their services are billed under the name of the regular physician they are temporarily replacing. This ensures that patients continue to receive care without disruption and that revenue generation remains consistent for the healthcare facility.
While this may sound simple, the billing process involves some specific guidelines and considerations, particularly when dealing with insurers, both commercial and federal.
The Medicare Rule
When billing for locum tenens providers, it is important to note that the governing rule for reimbursement comes from Medicare and is applied specifically to physician services under Medicare.
You will need to check with each payer individually to determine if they follow the Medicare rule. If not, you will need to request information and understand their specific guidelines for reimbursing locum tenens providers.
Billing for Locum Tenens: Breaking It Down Into Two Categories
- To bill for locum tenens services, it is important to first determine the type of temporary physician required: replacement physician services or supplemental physician services.
Replacement services apply when a locum tenens physician is filling in for a regular physician who is temporarily unavailable for 60 days or less. On the other hand, supplemental services are used when you need to add an extra physician to your staff, either to grow your practice or to cover an extended absence of more than 60 days.
In the following sections, we will break down both categories in more detail, providing guidelines on how to handle billing for each situation.
#1: Replacement Physician Services
Replacement physician services are utilized when a locum tenens provider is brought in to cover for a regular physician who is temporarily unavailable. This could be due to a variety of reasons, such as vacation, medical leave, continuing education, or military deployment. These temporary placements ensure continuity of care for patients while maintaining the revenue flow for healthcare facilities.
When it comes to billing for replacement physician services, the guidelines depend on how long the locum tenens provider is needed. Below, we break down the different requirements for short- and long-term replacements, as well as the exceptions to the standard rules.
Duration Lasting Less Than 60 Days
If the locum tenens provider is filling in for less than 60 days, the billing process is relatively straightforward, and the following conditions must be met:
- The regular physician must be unavailable to provide the services.
- The patients must have been expecting or arranged to receive care from the regular physician.
- The locum tenens provider must be paid on a per diem basis.
- The locum tenens provider’s services must not extend beyond 60 consecutive days.
- The regular physician’s information is used to submit a claim for the locum tenens services provided, and they can be billed as if the absent physician was providing the care.
Duration Lasting More Than 60 Days
In cases where a locum tenens physician is required for more than 60 days, the rules change. Medicare’s 60-day limit is not extended; however, there are a few options to continue billing for locum tenens coverage past this mark:
- The healthcare facility can begin enrolling the locum tenens provider in the organization’s contracted payer mix (Medicare, Medicaid, commercial payers, etc.). Once this is complete, the locum physician can be billed under their National Provider Identifier (NPI) number.
- The regular physician can return to work for a brief period and “reset” the 60-day window. This allows the locum tenens staffer to continue their services for another 60 days, and this process can be repeated as long as necessary.
Exceptions
The most notable exception applies when the regular physician is called to active duty in the military. In such cases, the locum tenens provider can continue to serve Medicare patients beyond the 60-day limit.
Other scenarios include:
- The absent physician’s contract with the practice may allow for a locum to replace them for longer periods, such as for extended medical leave or a sabbatical.
- If the locum tenens provider is enrolled in the payer system and their credentials are verified, they can continue to bill under their own NPI once the initial 60-day period expires.
#2: Supplemental Physician Services
Supplemental physician services are when a locum tenens provider is hired to fill an additional role within a practice rather than to replace an existing physician, nurse practitioner, or physician assistant. These services are commonly used by practices that are expanding their offerings, looking to grow their staff, or facing difficulty in finding permanent physicians.
Typically, these assignments last longer than 60 days. Not understanding the specifics of this type of service can be overwhelming, mostly regarding specific guidelines — for example, the Centers for Medicare & Medicaid Services (CMS) Manual System — for proper billing, reimbursement, and other legal aspects.
- Medicare will not cover extended services beyond 60 days unless there is an exception.
- Contracts for longer-term assignments should be clearly defined, outlining the scope of services, expectations, and duration of the placement.
- Contracts should also specify whether the locum tenens physician will be directly billing the payer.
- Many states have their own specific regulations regarding locum tenens billing for extended periods and the necessary licenses and credentials for the professionals to be able to practice in the state.
Common Misunderstandings Regarding Locum Tenens Billing
Forgetting the Q6 modifier is a very common mistake that will very likely cause your claim to be flagged or denied. The Q6 modifier is your way of letting Medicare know that the regular doctor did not provide this service.
Miscalculating the 60-day rule is also a pretty serious mistake. The 60 days can be consecutive or non-consecutive, and when you hit 61 days, you can no longer bill under the regular physician’s NPI.
Tips and Key Points To Remember When Billing for Locum Tenens Positions
Billing for locum tenens services can be complex, but there are several key strategies to ensure a smoother process:
- Always keep digital copies of required documents, such as licenses, DEA registrations, malpractice insurance, and references, readily available. This will speed up the approval process.
- If allowed, use expedited credentialing or temporary privileging fast-track options to accelerate provider approval.
- Verify state licensing requirements in advance, especially if the locum physician needs to work in a new state.
- Maintain detailed records of all services provided by locum tenens, as this will be essential for audits or potential malpractice suits. Electronic medical record systems make it easier to track claims and services.
- Partner with a reliable agency like Trusted Locum Staffing. Our talent advisors can simplify the process, as we handle everything from licensing and malpractice insurance to credentialing, ensuring you meet all the requirements with ease.
Specifications and Required Documentation for Locum Tenens Physicians
To ensure compliance and smooth billing for locum tenens services, the following specifications and documentation are required:
- The reason for the regular physician’s absence
- The start and end dates of the locum tenens assignment
- A copy of the locum tenens physician’s credentials and license
- A written contract or agreement between the locum tenens provider and the practice
- Detailed patient records outlining the services provided by the locum tenens physician
You can reach out to us anytime, and we’ll be happy to guide you through the process and help you navigate all the necessary documents you’ll need for the next steps, including:
- Medical school diploma and training certificates
- Current board certificates
- All current state medical license(s)
- Current driver’s license or passport
FAQs About Locum Tenens Billing
Where Can I Find Specifics About Payment Policies for Locum Tenens Physicians?
On the CMS website, you can find comprehensive details on payment policies, modifiers, and the conditions under which locum tenens providers can be billed. This is the official resource to ensure you’re in compliance with federal guidelines and can avoid any issues with reimbursements or audits.
What Is the Difference Between the Q5 and Q6 Modifiers?
The Q5 and Q6 modifiers are both used in locum tenens billing, but they serve distinct purposes.
The Q5 modifier is applied when a locum tenens provider is filling in for a physician under a fee-for-service arrangement in underserved areas, such as a health professional shortage area (HPSA), a medically underserved area (MUA), or a rural area.
The Q6 modifier is used when a locum tenens physician is temporarily replacing a regular physician due to reasons like vacation or medical leave, and the regular physician pays the locum on a per diem or similar fee-for-time basis.
Can Post-Operative Visits Be Billed Separately in Locum Tenens Agreements?
No, post-operative visits are generally not billed separately if they are included under the global surgical fee. Post-operative care provided by a locum tenens physician during the global period does not need to be identified separately on the claim.
However, if the locum tenens physician provides any additional services outside the scope of the global surgical package—such as treating unrelated conditions—those services can be billed separately.
What Are the Consequences if You Don’t Comply With Medicare Locum Tenens Rules?
Failing to include the Q6 modifier when billing for locum tenens services can result in claim rejection by Medicare.
If Medicare discovers that a locum tenens provider exceeded the 60-day limit, the facility may be required to repay any overbilled services.
Incorrect billing for locum tenens services can trigger an audit or, in severe cases, lead to allegations of Medicare fraud.
Simplify the Locum Tenens Billing Process With Trusted Locum Staffing
Our dedicated teams, including travel, compliance, and payroll, work closely with you to ensure everything including licensing and credentialing is handled with precision. With our white-glove concierge service, we handle all the details so you can focus on what matters most: providing top-quality care. Plus, we offer great benefits to support your success every step of the way.
Our experienced payroll team ensures you are paid accurately and on time, every time, and is always available to answer any questions about your wages, benefits, or deductions.
By partnering with Trusted Locum Staffing, you can rest easy knowing that every aspect of your locum tenens assignment, including billing, is in expert hands.ted Locum Staffing help you land a position in one of the best paying states for locum tenens providers today!
