It is a common practice for a doctor to find someone to cover for them while they are away from their office for a temporary or extended period of time.
Here’re some things you need to know when preparing for a “fill-in” doctor.
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Welcome to your billing and coding weekly solutions by American Acupuncture Council Network (AAC).
Do you ever need extended time away from your practice that requires a substitute or “fill-in” doctor to see your patients? You are not alone!
It is a common practice for a doctor to find someone to cover for them while they are away from their office for a temporary or extended period of time.
Here’re some things you need to know when preparing for a “fill-in” doctor.
1. A substituting doctor is really just a proxy and functions as if the regular doctor were present.
2. For most payers, the substitute physician does not need to be credentialed with the plan, but must possess an unencumbered license in the same specialty.
3. If the temporary doctor is hired on, then Medicare (and presumably most private plans) would require the new doctor to become enrolled before submitting claims.
4. Temporary doctors may not be used indefinitely, CMS limits locum tenens (latin for “to hold the place of”or “fill-in”) to 60 days, and most other payers probably have similar guidelines.
5. A “fill-in” doctor hired from the outside should be paid a per diem or on a fee for time basis as an independent contractor and the –Q6 modifier would apply.
6. When the covering physician is a permanent part of the office (under the same tax ID), this may constitute a reciprocal billing arrangement, and the –Q5 modifier would apply.
Important: A record must be kept of each service provided by the “fill-in”physician along with their physician identification number.
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.
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