In the healthcare setting, practices and hospitals frequently hire temporary providers, locum tenens physicians, derived from the Latin term meaning “to hold the place, to substitute for.” Locum tenens are contracted physicians who substitute for physicians when they are vacationing, sick, attending conferences, on maternity leave or have left a practice.
In the U.S., locum tenens were first used in the 1970s, and demand for these temporary physicians has quietly escalated over the past 15 years. The number of U.S. physicians working as locum tenens has steadily risen, from an estimated 26,000 physicians in 2002 to more than 56,000 physicians in the past few years. Utilizing locum tenens can be advantageous, but the rules must be followed to ensure proper reimbursement. The Centers for Medicare & Medicaid Services (CMS) allows payment for services provided by locum tenens, but practices need to follow the guidelines closely.
Identifying Locum Tenens
Locum tenens physicians don’t have to be enrolled in the Medicare program or be in the same specialty as the physician for whom they are covering, but they must have a National Provider Identifier (NPI) and possess an unrestricted license in the state in which they are practicing. A locum tenens physician cannot be used to cover expansion or growth in a practice. Medicare beneficiaries must seek to receive services from their regular physician, and services may not be provided by the locum tenens over a continuous period of more than 60 days (with the exception of a locum tenens filling in for a member of the armed forces called to active duty). Additionally:
- A practice can employ a locum tenens for only 60 days or less. Claims must be submitted under the absent physician’s NPI number and name, and the locum tenens physician is reimbursed by the practice.
- No extension can be granted for the 60-day maximum. If a physician will be out for more than 60 days, two alternatives exist:
- the practice may employ an additional locum tenens to take over, or
- the physician can return to work for a limited amount of time, which can be as little as one day. That restarts the 60-day time limit.
- The Q6 modifier must be placed in Box 24D on the HCFA 1500 form, signifying to Medicare that a locum tenens performed the service.
- The practice must keep on file a record of each service furnished by the locum tenens physician, with their NPI or Unique Provider Identification Number (UPIN).
In addition to maintaining the practice’s revenue stream, a locum tenens physician also ensures continuity of patient care. Patients can still see a physician within the practice setting without interruption, increasing their trust and willingness to work with the practice and making it less likely they’ll seek the care of another physician in your absence.
Note: Verify locum tenens policies with your state’s Medicaid office and commercial carriers; some may follow CMS policy, but others may require enrollment.