decisionhealth Newsletters, Answer Books - 2008 Issue 7 (July)
Medicare_Claims_Processing_Manual / Chapter_1 / 30.2.11
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Article Overview
This article covers Medicare payment policy for physician services furnished by substitute physicians under locum tenens arrangements. It is aimed at billing staff, physician practices, and medical groups that submit carrier claims and need to understand the general framework for reporting, documentation, and timing requirements discussed in the manual. The section also addresses special circumstances such as group practice billing, reciprocal billing references, and a temporary statutory exception tied to active military duty.
Why This Topic Matters
Locum tenens arrangements are common in physician practices, and proper handling of these claims affects whether services are payable and how they must be reported. This section is relevant for practices that manage coverage during physician absence and need to align claims processing with Medicare manual guidance.
Article Sections
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A. Background
Introduces the locum tenens concept and the general Medicare policy context for substitute physician services.
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B. Payment Procedure
Summarizes the carrier claim submission framework, including broad eligibility conditions, reporting elements, and a temporary statutory exception period.
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C. Medical Group Claims Under Locum Tenens Arrangements
Addresses how the policy applies in medical group settings and describes the general recordkeeping and claim-reporting considerations for group billing.
What You Will Learn
- How Medicare frames payment for substitute physician services under locum tenens arrangements
- What general claim submission and documentation topics are addressed for carrier claims
- How the guidance applies in medical group settings
- What special time-limited exception is discussed in the manual update
- What types of provider identifiers and claim fields are referenced in the policy
Who Should Read This
- Medical coders
- Billing staff
- Physician practice managers
- Revenue cycle teams
- Compliance staff
- Medical groups
- Carrier claims processors
Codes Discussed
Modifiers Discussed
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