Q/A: What are the Rules for a Fill-in (locum tenens) Doctor?

by  Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
Aug 17th, 2017 - Reviewed/Updated Feb 5th

Question

We are in need of a coverage doctor for two weeks, we would like to know the rules.

Answer

A locum tenens provider is one that works in the place of the regular physician for a short duration of time. Guideline typically allows this time period to be a 60 day maximum, when a substitute doctor would be brought in to your office to cover your original doctor's actual schedule during the time he/she is absent. Services by the Locum Tenens provider would be performed at the facility that your doctor's NPI and group are registered. When submitting claims for a locum tenens provider, your office or billing service would submit claims just as you do for your original provider, including using the original provider's NPI. The modifier Q6 must be appended to each service code rendered by the locum tenens provider. Locum tenens providers must be licensed in that state and able to fulfill the schedule and duties of the regular provider.

Note also that individual carriers may have their own rules in addition to what is standard for locum tenens providers. As a result, before making an assumption that coverage and benefits would remain the same, it would be good to check with those carriers and obtaining their written policy regarding locum tenens.

About Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

Brandy is a Certified Professional Coder (CPC), Certified Medical Compliance Officer (CMCO), ChiroCode Certified Chiropractic Professional Coder (CCCPC), a Certified Professional Compliance Officer (CPCO)and a Certified Professional Medical Auditor (CPMA). She is also the President of CHelpDesk Solutions (www.CHelpDesk.com), chiropractic's on-demand Certified Virtual Chiropractic Assistant.

Brandy is a member of the AAPC (American Academy of Professional Coders), PMI (Practice Management Institute), and the ACA (American Chiropractic Association).