You cannot bill ‘extra help’ under lt rules.
One of your full-time physicians goes on vacation – or sabbatical or maternity leave. Your practice employs a locum tenens (lt) to fill in for the missing physician.
No problem, until you try to bill for the substitute physician’s services with Medicare – or payers who follow Medicare’s billing guidelines. Check out this primer on locum tenens billing, and look for further lt stories in future blog posts.
In short: A locum tenens physician must be substituting for another physician, according to Jill Young, CPC, CEDC, CIMC, owner of Young Medical Consulting in East Lansing, Mich. In other words, you can’t hire an lt as “extra help” if your practice experiences a temporary surge in business.
There are three rules you must remember when you are billing for an lt physician:
Example: Your practice hires an lt physician to fill in for Dr. X, who is on a teaching sabbatical. The lt physician performs a level-two E/M service for an established patient. On the claim, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making…) for the lt’s services under Dr. X’s Medicare ID number.
Example: Dr. Y goes on maternity leave March 1, and you hire an lt physician to fill in for Dr. Y. The lt performs his first service for a patient on March 3.
In this example, the lt physician can bill under Dr. Y’s Medicare ID until May 1; 60 days after the March 3 service.