decisionhealth Newsletters, Part B News - 2026 Issue 6 (June)
Locum tenens, substitute providers see denial variability
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Article Overview
This article examines Medicare claims data on locum tenens and substitute-provider billing arrangements and how denial rates vary by specialty. It is relevant to physicians, group practices, substitute providers, billing staff, and compliance teams who work with Medicare Part B claims. The discussion centers on broad utilization patterns, specialty-level denial variability, and the modifiers used in these arrangements.
Why This Topic Matters
Understanding how denial rates vary across specialties can help organizations monitor claim performance, identify areas with unusually high denials, and review whether billing workflows for substitute-provider services are being handled consistently.
Article Sections
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Benchmark of the week
Introduces the topic and frames the article as a claims-denial benchmark discussion for substitute-provider billing arrangements. It also identifies the general services and claim-processing context covered in the article.
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Specialty-level denial patterns for Q5 claims
Summarizes claim volume and denial variability across specialties for one of the modifier-based billing arrangements discussed in the article. Broad specialty-level trends are highlighted.
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Specialty-level denial patterns for Q6 claims
Summarizes claim volume and denial variability across specialties for the other modifier-based billing arrangement discussed in the article. Broad specialty-level trends are highlighted.
What You Will Learn
- How Medicare claims denial rates vary across specialties for substitute-provider billing arrangements.
- Which broad claim-processing themes are associated with modifier-based locum tenens billing.
- What types of specialty-level utilization and denial patterns are discussed in the article.
- How Part B claims data are used to benchmark these billing arrangements.
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance professionals
- Physician practices
- Group practices
- Substitute providers
- Health system administrators
Codes Discussed
Modifiers Discussed
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