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Locum Tenens and Your Practice

locum tenens

Recently one of our clients asked us if they could use locum tenens while they were on vacation.  As summertime approaches, this question may be on everyone’s mind, so it seems like a good time to review acceptable and unacceptable uses of a locum tenens.  After all you don’t want to arrange for coverage of your practice and then not get reimbursed for the services rendered.

For Medicare eligibility and reimbursement, specific criteria must be met for a legitimate locum tenens, or fee-for-time compensation arrangement:

  • The substitute provider can only bill under the regular provider’s National Provider Identifier, or NPI, number for 60 continuous calendar days, unless the regular physician was called to active military duty.
  • The patients must seek the services of the regular physician.
  • Claims submitted to Medicare must use the modifier “Q6,” to indicate the use of a locum tenens.
  • The substitute physician must not be an employee, but an independent contractor.
  • The substitute physician must be paid on a per diem or similar time basis.

What Are Acceptable Uses of a Locum Tenens?

Examples of acceptable uses for a fee-for-time compensation arrangement include the following scenarios:

  • A physician takes a leave or goes on vacation. During that time, another physician sees that physician’s patients. Those visits can be billed to Medicare under the regular physician’s name, and Medicare will reimburse the regular physician as if she performed the services.
  • A physician terminates from the group. While the group tries to recruit a replacement, a substitute physician covers that physician’s caseload for up to 60 days.
  • Two locum tenens providers cover the panel of a physician on leave for 60 days, alternating the weeks they work.

What Are Unacceptable Uses of a Locum Tenens?

For Medicare purposes, the following are unacceptable uses of a fee-for-time compensation arrangement:

  • If a physician dies, no one can bill under that physician’s name.
  • Locum tenens arrangements for Medicare do not include nurse practitioners, physician assistants or any other provider type besides physician and physical therapist (in certain geographies or region). However, they do not need to be of the same specialty.
  • A newly hired physician cannot bill as a locum tenens provider while pending Medicare enrollment; employees do not qualify.
  • You are expanding your practice and need additional providers. A fee-for-time arrangement would not qualify, since there is no regular physician to substitute for.
  • The regular physician cannot provide services elsewhere while a substitute physician also is billing under her credentials; the regular physician cannot be available to work.

The above rules apply to the Medicare program. Different insurance plans can have their own rules regarding the allowed use of a substitute physician, but most will follow Medicare.  However, it is always a good thing to check with each carrier.

“Tiger” Focus by Scott Ballard

2020 is well underway. I don’t know about you, but I found myself juggling my ‘to-do’ list.  Every day, it seemed I was jumping from one thing to another and adding more things to my already robust list.  I had so many projects, micro-enhancements, things that would make the staff more efficient and be value added to our clients.

I make lists and I’m pretty organized but even with that I seemed to come up short.  I’m always looking for a better way for something that will help me focus on what is important and pursue it with maniacal intensity.

And then I read an article called “Tiger” Focus by Confidence Coach Scott Ballard.  I shared it with a few colleagues, and they had the same reaction I did.  It leaves you with a sense of ‘wow’ so simple but often over-looked.  And now when I seem to stray, I think ‘Tiger Focus’.  It is a quick read but one that you can apply to your business and personal life.

Who is the MVP in your Office?

Every person, every task, every patient is important, but the front desk is the quarterback for the office. They set everything in motion. They get the nod as the MVP.

Scheduling the patient is the easy part but everything after that is tricky at best and of paramount importance. Before the patient comes in benefits need to be confirmed, referrals and pre-authorizations must be obtained and recorded.

Once the patient presents at the office there is a whole new set of responsibilities and must be done with laser accuracy. It doesn’t matter how good the nursing staff is or how good the doctor is because if the front desk didn’t do their job then that visit won’t get paid.

Maybe you think registering patients is easy, but it isn’t. This requires that all the patient’s information and the responsible party’s information be recorded accurately. It isn’t enough to just ask if anything has changed you must confirm all demographics and then make sure that the current insurance card is scanned into the record. People change jobs, move, and get married and companies change insurance plans and so it is important to check every time. Also, the patient’s name and the responsible party’s name, if any must be recorded in the chart exactly as it appears on the insurance card. If the front desk isn’t looking at that card and scanning it into the record, then that is a fumble and will cost you.

As the patient is checked in or as they schedule their follow-up visit take the time to collect copays and deductibles. This is critical during the first part of every year since patients haven’t met their deductibles yet. If your front desk staff is asking for payment at the time of service, then you have a very valuable team player. Lots of people are uncomfortable doing this so make sure your front desk staff has the skill set to ask for payment. Your patients won’t get as many billing statements and your practice will be rewarded with improved cash flow.

It’s true – it takes everyone on the team to make a practice successful and maybe you are lucky and have several MVPs but make sure one of the MVPs is at your front desk!

Does Your Medical Practice Need a Website?

website must haves

8 Website Must Haves…

website must haves

Medical practices often asked for our opinion about the value of a website for the medical practice.  We are not website professionals.  However, we have had the pleasure of working with some very talented design and development people. Thanks to their input, as well as numerous articles, the consensus is a resounding “Yes”!

Regardless of  your specialty, the reality is people are searching online for you.  They are interested in who you are, what your credentials are and about your practice.  They are trying to determine if they will feel comfortable with you.  Whether you realize it or not, people search the web and make decisions based on your website.

It is true that potential patients may still make an appointment with you if they can’t find you on social media or if you don’t have a website but why leave it to chance?  So if you are thinking about development, re-design or updating we thought you might find the following article of use, The 8 Must-Haves for Your Medical Practice Website. 

Telemedicine – Fad or Future?

In 1968, a book called Five Patients introduced America to telemedicine.  At that time, it seemed more like science fiction than reality.  The book was written by Michael Crichton, who would later become famous for a better known book, Jurassic Park.  Skip ahead to 2015, the Mordor Intelligence report predicted that the telemedicine market will grow to be greater than $34 billion by the end of this decade.  And in February of this year, the Mordor Report was updated and now predicts that the telemedicine market growth will reach $66 billion by 2021.

As the cost of healthcare continues to rise, deductibles continue to increase and companies drop health benefits altogether, telemedicine offers an appealing alternative to traditional healthcare settings.  Telemedicine works well for the elderly, those in care for chronic disease, time bound individuals and the less mobile or rural populations.

Advocates of telemedicine cite several benefits.  Not the least of which is convenience. Patients could access their provider virtually on demand.  It is anticipated that hospital admissions and readmissions will be decreased because of improved patient compliance and ongoing monitoring.  Patients who live in rural areas will have greater access to care and those who are time-bound would be more inclined to set a telemedicine visit then to try and schedule a traditional visit.

The Challenges

Despite the positive aspects, there are factors that stand in the way of immediate growth.  One of the challenges is that many providers 55 or older are more comfortable practicing medicine in traditional settings.  The older they get the less likely they are to want to make changes in how they practice medicine.  And then there are reimbursement and legal issues.  Currently, telemedicine laws for reimbursement are handled state-by-state.  Inconsistencies in reimbursement and legal definitions of what constitutes care are continually addressed by organization like the American Telehealth Association.

It is not unreasonable to assume that such hurdles will be overcome and that telemedicine will indeed grow.  Many have embraced technology and more will demand such access.  More and more physicians will adopt telemedicine in their practices to bring convenient, low-cost, high-quality care to their patients.  Undoubtedly, future physicians and providers will see telemedicine as simply another tool to serve and care for their patients.

For state-by-state information visit the ATA State Policy Resource Center.

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