FROM: PAUL SWATSENBARG, Deputy Administrator
Division of Medicaid
Effective August 1, 2001, Medicaid will allow for Physician’s to bill for Locum Tenens and Reciprocal billing arrangements using the following guidelines:
Locum Tenens/Reciprocal billing. The practice for physicians to retain substitute physicians to take over their professional practices when the regular physicians are absent for reasons such as: illness, pregnancy, vacation, or continuing medical education, and for the regular physician to bill and receive payment for the substitute physician’s services as though he/she performed them. These substitute physicians are generally called, “locum tenens” physicians.
Locum Tenens occurs when the substitute physician covers the regular physician during absences not to exceed a period of 90 continuous days.
Reciprocal Billing occurs when substitute physicians cover the regular physician during absences and or on an on-call basis not to exceed a period of 14 continuous days.
Procedure For Locum Tenens and Reciprocal Billing Claims.
In reimbursement for Locum Tenens/Reciprocal Billing the patient’s regular physician may submit the claim and receive payment for covered Medicaid services (including emergency visits and related services) provided by a locum tenens physician who is not an employee of the regular physician. Services for patients are not restricted to the regular physician’s office. Services are reimbursable if:
1. The regular physician is unavailable to provide the services.
2. The Medicaid patient has arranged or seeks to receive services from the regular physician.
3. The regular physician pays the locum tenens for his/her services on a per diem or similar fee-for-time basis.
4. The substitute physician does not provide the services to Medicaid patients over a continuous period of longer than 90 days for Locum Tenens and over a continuous period of 14 days for Reciprocal Billing.
5. The regular physician identifies the services as substitute physician services meeting the requirements of this section by appending the appropriate modifier:
Q6 (service furnished by a locum tenens physician) to the end of the procedure code,
Q5 (service furnished by a substitute physician under a reciprocal billing arrangement) to the end of the procedure code.
6. The regular physician must keep on file a record of each service provided by the substitute physician, associated with the substitute physician’s UPIN, and make this record available to the Department upon request.
7. If the only substitution services a physician performs in connection with an operation are post-operative services furnished during the period covered by the global fee, those services should not be reported separately on the claim as substitution services.
8. A physician may have locum tenens/reciprocal billing arrangements with more than one physician. The arrangements need not be in writing.
Questions regarding this Information Release should be directed to Esther Ussing, R.N. at (208) 364-1835 or (208) 334-5795. Thank you for your continued participation in the Idaho Medicaid Program.