by Dr. Michael Warshaw, DPM, CPC
Under reciprocal billing arrangements, a patient’s absentee physician may submit a claim and receive payment for services arranged to be provided by a substitute physician on an occasional basis. The regular physician should identify the service as substitute physician services and bill with the Q5 modifier (service furnished by a substitute physician under a reciprocal billing arrangement).
A reciprocal billing arrangement is typically an agreement among physicians that one will cover the others practice when the physician is absent. Reciprocal billing arrangements are usually informal, and Medicare does not require them to be in writing. The absentee physician compensates the covering physician by reciprocating in the future. Physicians may have reciprocal billing arrangements with more than one physician.
Coverage periods for reciprocating physicians are typically brief, although Medicare will allow them to last up to 60 days if certain criteria are met. A typical example of a reciprocal billing arrangement is a physician who covers for an absentee physician who is on-call for the weekend.
Q5 Definition: Services furnished by a substitute physician under a reciprocal billing arrangement.
Appropriate Usage
When a physician agrees to see patients of another physician under arrangements of the original physician
• The regular physician is not available to see patients
• The patient arranges or seeks service of their regular physician
• Short term coverage provided, under 60 days
• When a group member acts on behalf of a hospice attending physician
Inappropriate Usage
• When the physician is covering for an absence of a long term
• When the physician is in the same group and same specialty
Locum tenens’ are substitute physicians who assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, or continuing medical education. The substitute physicians generally have no practice of their own and move to various facilities as needed. Medicare rules require that locum tenens cannot provide services for longer than 60 days.
The absentee physician pays the locum tenens physician an agreed upon rate, with the locum tenens acting as an independent contractor rather than an employee. The absentee physician may submit a claim using the Q6 modifier (services furnished by a locum tenens physician). Also, the regular physician must keep on file a record of each service provided by the locum tenens along with the locum tenens’ UPIN.
Q6 Definition: Services furnished by a Fee-For-Time Compensation Arrangements physician.
Appropriate Usage
• When a physician agrees to see patients of another physician under arrangements of the original physician
• The regular physician is not available to see patients
• The patient arranges or seeks service of their regular physician
• Short term coverage provided, under 60 days
• The physician seeing the patient is not in practice for themselves, or employed as part of another practice
Inappropriate Usage
• When the physician is covering for an absence of a long term
• When the physician is in the same group
• When the absent physician is deceased and the group is attempting to re-use their PTAN number
This is my opinion.
Michael G. Warshaw
DPM, CPC
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FAQs
Locum tenens occurs when the substitute physician covers for the regular physician during absences not to exceed a period of 90 continuous days. Reciprocal billing occurs when substitute physicians cover the regular physicians during absences and/or on an on-call basis not to exceed a period of 14 continuous days.
What is locum tenens billing? ›
A1: The Latin phrase “locum tenens” refers to the practice of hiring substitute physicians to fill in for regular physicians during their absence. It allows the regular physician to bill and receive payment for the substitute physician's services as if they provided the care themselves.
What is a reciprocal billing arrangement with Medicare? ›
A reciprocal billing arrangement is typically an agreement among physicians that one will cover the others practice when the physician is absent. Reciprocal billing arrangements are usually informal, and Medicare does not require them to be in writing.
What is the difference between Loc*ms Tenens and per diem? ›
Key Differences Between Locum Tenens and Per Diem
Locum tenens positions can last from a few days to several months, while per diem roles are typically short-term, often on a daily basis.
What is the meaning of locum tenens? ›
To go by the literal locum tenens definition, translated from Latin, it means "to hold the place of, to substitute for." Locum tenens providers work at healthcare facilities on a temporary basis to fill gaps in care or occupy vacant positions until a full-time provider can be found.
What is a locum tenens agreement? ›
A locum contract is the work agreement between a physician and a locum tenens company or a hospital/clinic. At the core, it's a contract a physician independent contractors sign with their temporary employers that determines how much they will be paid, contract termination, and other important clauses.
Do locum tenens need to be credentialed? ›
The answer is yes. State and federal laws require hospitals to have a process in place to screen all applicants and assess their professional abilities. That's why physicians, physician assistants, and nurse practitioners must undergo a thorough credentialing process prior to taking on a locum tenens assignment.
What is a locum tenens in CMS? ›
By LuAnn Jenkins, CPC, CPMA, CMRS, CEMC, CFPC. Locum tenens is a Latin phrase that means “(one) holding a place.” In the medical field, locum tenens are contracted physicians who substitute for a physician who has left the practice, or who is temporarily unavailable (e.g., on medical leave, on vacation, etc.).
What modifier to use for locum tenens? ›
The Q6 modifier is important to healthcare because it allows healthcare facilities to identify and bill for locum tenens services.
What is an example of a reciprocal arrangement? ›
Examples of reciprocal arrangement
Our objective must be global disarmament, and this must be a reciprocal arrangement. Mutual assistance is a reciprocal arrangement in which part of the burden of dealing with each other's tax evasion problems is shared.
A reciprocal agreement is an arrangement between two or more states that allows residents of one state to work in another state without having to pay state income taxes to both. Under these agreements, employees only pay income taxes and file a tax return in their home state (i.e., the state where they live).
What is a reciprocal bill? ›
Reciprocal Billing states that individuals who are not present (either travelling or changing their residence) within their province or territory of residence at the time of needing a specific medically necessary service or procedure are to be either covered or reimbursed in full of the monetary costs by their ...
Why choose locum tenens? ›
Local locum tenens jobs facilitate ease of travel, the ability to manage work/life balance, and the chance to deliver care in your community. Local assignments also offer an educational window into other local health systems and settings.
How does loc*ms billing work? ›
The patient has arranged or seeks to receive the visit services from the regular physician. The locum tenens provider is paid for his/her services on a per diem or similar fee-for-time basis. The substitute physician does not provide services to Medicare patients over a continuous period of longer than 60 days.
Why does locum tenens pay more? ›
You can earn even more as a locum by being willing to travel to remote or rural areas that need providers. You can also earn more by working nights, weekends, extended shifts or holidays. If you specialize in an area that is particularly difficult to fill or have a unique skill set, you may also be in greater demand.
Can you bill for a nurse practitioner locum tenens? ›
The CMS billing guidelines for locum tenens physicians do not apply to nurse practitioners and physician assistants. The directions for billing locum tenens NP and PA services differ from state to state. Contact your local Medicare Administrative Contractor to find out if using modifier Q6 is appropriate.
What is the difference between Q5 and Q6 modifier? ›
Use Q5 when there is a reciprocal billing arrangement and use Q6 when there is a fee-for-time compensation arrangement. Medicare has some specific rules about the time involved so be aware of individual payer policies and their time requirements.
What is the difference between locum tenens and moonlighting? ›
Locum tenens jobs are usually for a definite amount of time, whereas in moonlighting, the person might have awkward hours for their shift. Medical physicians, osteopaths, nurse practitioners, registered nurses, and pharmacists can all find “loc*ms' positions” at various sizes of healthcare institutions.
What is the difference between locum tenens and temporary staffing? ›
A real locum tenens provider can only fill in for a co-worker for a total of 60 days in a row. Temporary medical physician jobs, on the other hand, may work for more than 60 days in a row and are subject to various credentialing and billing prerequisites.
