Article on Part B News by Roy Edroso
Question: Some of our clinical staff is going on vacation and we’re going to bring in locum tenens providers to cover for them. We have a physician assistant (PA) who wants us to swap in a fellow PA who freelances in a reciprocal billing arrangement. Can we do that?
Answer: First, though “locum tenens” is still an in-use term, be aware that CMS has officially discarded the term because the 21st Century Cures Act “uses ‘locum tenens arrangements’ to refer to both fee-for-time compensation arrangements and reciprocal billing arrangements,” CMS said in a 2017 MLN Matters. “As a result, continuing to use the term ‘locum tenens’ to refer solely to fee-for-time compensation arrangements is not consistent with the law and could be confusing to the public.”
One reason it might be confusing is that clinical employment agencies often refer to temp jobs for physician assistants and nurse practitioners as “locum tenens” assignments. But if you tried to bill such arrangements to Medicare with the modifier Q6 (Services furnished by a fee-for-time compensation arrangements physician) or a reciprocal arrangement such as you describe, with the modifier Q5 (Service furnished by substitute physician under reciprocal billing arrangement), you would get denied, because Medicare only allows physicians (M.D.s and DOs) to enter into those arrangements.
The one exception is stipulated in the Cures Act: A physical therapist in a health professional shortage area (HPSA), a medically underserved area (MUA) or in a rural area may make such arrangements. Otherwise it’s physicians-only. Other payers may have their own, more forgiving rules, so if you do enough private payer business to make it worth your while you should check. “One of the biggest mistakes is that offices assume that they only need to check the Medicare policy on how to follow the guidelines,” says Tina Hsiao, COO of EHR company Soundry Health in Los Altos, Calif. Hsiao adds that while these payers may be more flexible in some areas, they may be tougher in others: “They could require the provider to actually be added to the insurance contract.”
Mind other locum tenens guidance
- 60 days, no more. CMS made an exception for this locums limit for the pandemic, provided the physician or physical therapist changed their substitute on the 61st day, and allowed it to extend past the end of the public health emergency — but only until July 10, 2023. As such, the over-60-day extension has expired.
- Not for not-yet-enrolled new docs. If you have a new physician who’s waiting on their Medicare enrollment to come through, it’s not OK to get them in under an enrolled provider’s NPI; in fact, providers have been nailed for fraud on that basis (PBN 3/2/20).
- Not for dead docs, either. If your physician passes away, you can’t have a locums physician operate under their NPI (PBN 7/6/17).