Outpatient Facility Coding Alert - 2010 Issue 2
PART B MYTHBUSTER: Avoid Billing Locum Tenens For New Docs Who Aren't Yet Credentialed
Subscribe or sign in to view the full article.
Article Overview
This Medicare Part B article addresses locum tenens billing in physician practices and explains why the arrangement is not meant to cover a newly hired doctor who is still awaiting credentialing. It summarizes the general Medicare guidance, the role of the temporary physician in the billing process, timing limits, and the compliance concerns that arise when claims are submitted under another physician’s identifier. The article is intended for coders, billers, practice managers, and physicians responsible for Medicare claims compliance.
Why This Topic Matters
It helps practices avoid billing patterns that may create compliance risk when onboarding new physicians and clarifies the difference between legitimate temporary coverage and improper claim submission during credentialing delays.
Article Sections
-
Locum Tenens Billing and Medicare Guidance
Introduces the Medicare framework for temporary physician coverage and the general circumstances discussed in the article. It also describes the source of the guidance referenced by the author.
-
Why New Physician Credentialing Delays Do Not Fit the Scenario
Explains the common practice concern that prompted the article and outlines the compliance concerns tied to treating a new hire as temporary coverage. The section frames the issue from a Medicare billing perspective.
-
Billing Process and Time Limits for Locum Tenens
Summarizes the operational elements of reporting temporary coverage, including the use of the relevant modifier, billing under the appropriate physician identifier, and the temporary nature of the arrangement. It also notes timing limitations discussed in the article.
-
Compliance Risks and OIG Commentary
Describes the risk of omitting required identifiers and the broader compliance concern raised by federal program oversight. It also references the article’s discussion of misrepresentation and audit exposure.
What You Will Learn
- How Medicare generally frames locum tenens coverage
- Why credentialing delays for a new physician are treated differently
- What documentation and claim-submission elements are discussed for temporary coverage
- What compliance issues can arise when claims are billed under another physician’s identifier
Who Should Read This
- Physician practices
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
- Physicians
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com