Master the upcoming ICD-10 code and IPPS changes! Prepare your team for the upcoming changes taking effect on October 1. Discover the benefits of IPPSPalooza and how it can drive your success. Click here >

Abusing Locum Tenens Billing

I was shocked, and very concerned when I recently looked at a physician department staffing sheet of a client.

Three of 12 positions had “locum” entered into the space for physician names. Digging a little deeper, I found out that since they had not been able to fill these positions, they had covered the services using a physician staffing service that continued to bill under the name of a physician who had retired from the hospital.

Locum tenens is Latin for “place holder.” In medicine, using the term was initiated to allow physicians to take time off for vacations and other personal reasons, without replacing the physician. Additionally, the idea was that while the physician being covered was away, he or she paid the “locum tenens” physician to take over their responsibilities. That is why physicians being covered by another physician under a locum tenens agreement continued billing under their billing number.

You might wonder why the hospital did not simply bill under the number for the physician from the temporary agency. In order to bill that way, they would have to have had them credentialed. The current backlog with their Medicaid managed care group was six months, in the state in which the hospital was located.

Section 30.2.11 of the Medicare manual covers billing for locum tenens services. It allows a practice to bill for temporary physician services during the absence of a regular physician who normally would have been scheduled to see a patient. For this type of reimbursement to take place, the regular physician arranges coverage for no longer than 60 continuous days, and then enters HCPCS code modifier Q6 after the procedure code during the billing process.

Despite the tremendous need, using the locum tenens service eventually caught up with this hospital. The Medicaid managed care plan noticed that the hospital was billing under a physician number after the 60-day cutoff, and started denying claims. Even worse, the Medicaid managed care plans found out that the physician whose number they were billing under had retired. The physician’s license was still valid for a while more, but they were no longer practicing medicine.

What should hospitals do about locum tenens billing? First, make sure your credentialing department keeps a list of all locum physicians. See if there is a plan in place to credential physicians who might exceed the 60-day limit. Make very sure that the locum modifier is being used for services provided by locums. Finally, make sure that locum tenens billing is addressed in your compliance plan.

Programming Note: Listen to Timothy Powell report the latest healthcare news on Talk Ten Tuesdays, 10-10:30 a.m. EST.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn
Email
Print

Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

Related Stories

Time for Spring Cleaning

Time for Spring Cleaning

This article is about spring cleaning your coding and billing! There are a few concerns coming to light that need tidying up. These include the

Print Friendly, PDF & Email
Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

The CMS Two-Midnight Rule and short-stay audits are here to stay, impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D. New for 2024, the Two-Midnight Rule applies to Medicare Advantage patients, requiring differentiation between Medicare plans affecting Case Managers, Utilization Review, and operational processes and knowledge of a vital distinction between these patients that influences post-discharge medical reviews and compliance risk. Join Michael G. Calahan for a comprehensive webcast covering federal laws for all admission processes. Gain the knowledge needed to navigate audits effectively and optimize patient access points, personnel, and compliance strategies. Learn Two-Midnight Rule essentials, Medicare Advantage implications, and compliance best practices. Discover operational insights for short-stay admissions, outpatient observation, and the ever-changing Inpatient-Only Listing.

Print Friendly, PDF & Email
September 19, 2023
Secondary Diagnosis Coding: A Deep Dive into Guidelines and Best Practices

Secondary Diagnosis Coding: A Deep Dive into Guidelines and Best Practices

Explore comprehensive guidelines and best practices for secondary diagnosis coding in our illuminating webcast. Delve into the intricacies of accurately assigning secondary diagnosis codes to ensure precise medical documentation. Learn how to navigate complex scenarios and adhere to coding regulations while enhancing coding proficiency. Our expert-led webcast covers essential insights, including documentation requirements, sequencing strategies, and industry updates. Elevate your coding skills and stay current with the latest coding advancements so you can determine the correct DRG assignment to optimize reimbursement, support medical decision-making, and maintain compliance.

Print Friendly, PDF & Email
September 20, 2023
Principal Diagnosis Coding: Mastering Selection and Sequencing

Principal Diagnosis Coding: Mastering Selection and Sequencing

Enhance your inpatient coding precision and revenue with Principal Diagnosis Coding: Mastering Selection and Sequencing. Join our expert-led webcast to conquer the challenges of principal diagnosis selection and sequencing. We’ll decode the intricacies of ICD-10-CM guidelines, equipping you with a clear grasp of the rules and the official UHDDS principal diagnosis definition. Uncover the crucial role of coding conventions, master the sequencing of related conditions, and confidently tackle cases with equally valid principal diagnoses.

Print Friendly, PDF & Email
September 14, 2023
2024 IPPS Summit: Final Rule Update with Expert Insights and Analysis

2024 IPPS Summit: Final Rule Update with Expert Insights and Analysis

Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY24 Inpatient Prospective Payment System (IPPS) Final Rule, including new ICD-10-CM/PCS codes, plus insights, analysis and answers to questions from the country’s most respected subject matter experts.

Print Friendly, PDF & Email
2024 IPPS Summit Day 3: MS-DRG Shifts and NTAPs

2024 IPPS Summit Day 3: MS-DRG Shifts and NTAPs

This third session in our 2024 IPPS Summit will feature a review of FY24 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts

Print Friendly, PDF & Email
August 17, 2023

Trending News