How to bill for services provided by a substitute doctor

January 22, 2010 — ACA has recently received a number of inquiries on how to bill for services provided by a substitute doctor or “locum tenens.” A locum tenens is retained by a provider or clinic when the regular doctor has to take a leave of absence for reasons such as vacation, illness, or pregnancy.

Medicare rules usually dictate that a locum tenens cannot provide services for longer than 60 days. The regular physician generally pays the locum tenens a fixed-rate, per diem amount, with the locum tenens having the status of an independent contractor rather than an employee. The regular physician may submit the claim using the Q6 modifier (services furnished by a locum tenens physician).

Additionally, the regular physician must keep on file a record of each service provided by the locum tenens along with the locum tenens’ National Provider Identifier. It is a good practice to retain a current copy of the locum tenens’ malpractice coverage.

However, for commercial carriers, networks, and third-party administrators (TPA), the answer is not so simple, and is one that requires a bit of advance research, when possible.

Each company has its own policy for billing for locum tenens. ACA strongly advises practices to contact the provider relations department of each carrier with which the regular doctor is contracted, and ask for its policy on billing for locum tenens.

For example, some carriers require that the locum tenens be a participating provider with their plan in order for services to be reimbursed.

Although calling each carrier does require some investment of time for practice staff, it is important for practices to perform due diligence in order to be properly reimbursed for services provided by locum tenens.

If you have any additional questions regarding locum tenens billing, please contact ACA’s Insurance Relations Department at insinfo@acatoday.org.

Source: American Chiropractic Association, www.acatoday.org