Billing & Coding: 4 Things to Know About the Substitute Doctor Rules

Welcome to your billing and coding weekly solutions by American Acupuncture Council Network (AAC).

Are you planning a little time away from your office and need to get a substitute doctor to fill-in for you?

Here are a 4 thing you need to know about the Locum Tenens or substitute doctor rule.

1. Locum Tenens or the substitute physician rule is a Medicare regulatory rule and not all commercial payers follow it.

It is important to check provider contracts and reimbursement policies carefully before billing locums services.

2. Under a locums or reciprocal billing arrangement all services performed are reported under the name/national provider identifier (NPI) of the absent regular provider.

3. The services of a locums physician are reported (where permitted) with Modifier Q6 or as directed by the payer.

Modifier Q5 is appropriate for services reported under a reciprocal billing arrangement.

4. The substitute physician cannot be an associate or even an Independent Contractor who commonly works at the practice.

It must be a temp (fill-in) who is usually an employee of a temp firm and therefore a leased employee of the practice.

Remember, billing with incorrect acupuncture CPT and ICD codes can lead to claim rejections and delays in payments, which can have a devastating impact on generating revenue and keeping you in business. 

If you are experiencing insurance claim denial, staff spending too much time trying to get claims paid, and patients asking why their claims have not been paid then American Acupuncture Council Network is your solution.

American Acupuncture Council Network stays ahead of the curve on the latest trends and changes in billing and coding by utilizing their direct channel of communication with the insurance companies and organizations that set the guidelines.

There is a reason acupuncturists have trusted AAC with their business for over 30 years.