Know Your Medicare Billing Rules for Locum Tenens

Authored by: Jean Kaiser, Regional Sales Executive, ebix Inc.

Thinking of taking some time off? If you’re a physician who wants to continue billing Medicare Part B for services rendered by a locum tenens substitute, there are certain rules you need to know.

Two Medicare Paperwork Musts

Here are the two items you must keep in mind when billing Medicare for services performed by a locum tenens physician.

  1. List in item 24d modifier – Q6 (services finished by a locum tenens physician) after the procedure code.
  2. In item 33a, enter the National Provider Identifier (NPI) for whom the substitute physician is to cover. If the absentee physician is part of a group, enter the group NPI in 33a and the individual NPI in item 24j.

A patient’s regular physician may receive Medicare Part B payment, for covered visit services of a locum tenens physician who is not an employee of the regular physician. However, one of the Medicare conditions for locum tenens service is that the substitute physician does not provide services to Medicare patients over a continuous period of longer than 60 days.

Physicians billing under locum tenens must make sure there is a definite break in coverage after 60 days of continuous coverage. Current Medicare policy allows physicians to cover absences of longer than 60 days by hiring multiple substitute physicians. For example, if a physician needs to be absent from his or her medical practice for 120 days, the absent physician may need to hire one locum tenens physician to work the first 60-day period and a different locum tenens physician to work the second 60-day period.

As an alternative to hiring more than one locum tenens physician, a physician could return to work in his or her practice for a short period of time to reset the 60-day clock.

Congress passed an exception to the 60-day limit for physicians being called to active duty in the armed forces. There is no time limit for locum tenens physicians substituting for physicians called to active duty.

Finally, physicians leaving a medical group on a permanent basis must enroll in the Medicare program and must either reassign payment for his/her services or bill themselves (in their own name and billing number). When a physician permanently leaves a practice, a substitute or temporary physician is filling a staff void, rather than substituting for a regular physician of a medical practice.

About ebix Inc.
For over 35 years, ebix Inc. has been providing medical billing services for independent physician practices and clinics. ebix serves hospital based practices, such as emergency departments, to maximize their revenue.  For an average client, ebix generates an additional 10% of revenue per year. It is done through their proprietary process of:coding expertise, denials minimization and data analytics.