Your service claims will be accurate if you know how to bill non-credentialed providers. This will also help you avoid regulatory errors that could lead to audits and, worse, fines. For a non-credentialed clinician who is new to your urgent care practice, it can be difficult to comprehend how to bill and receive payment. Here is the list of causes:
Reason #1: Permanent Full-time or Part-time Recruit
In care facilities, new providers are expected to manage more patient inflow. A clinic owner may not have four to six months' notice to fully credential a new clinician, especially if the need is unanticipated.
Reason #2: Temporary or Substitute Hire
Due to an unanticipated loss of a doctor like leave without prior notice or termination, the care facility may need to fill the vacancy at the earliest. Or else, it could be a temporary arrangement if a clinician is absent for reasons such as illness, pregnancy, vacation, or other reasons.
Hence, care facilities frequently utilize a non-credentialed provider. At the same time, they would request the billing companies to either bill for the new doctor under another specialist's name or the facility's name.
The response is: It depends on the circumstances. It is essential to keep in mind that while commercial insurance carriers each have their requirements, Medicare has its own set of rules that are distinct from those of other insurance payers.
You'll have to give close consideration to your payer contracts to charge for non-credentialed and non-contracted providers accurately. You cannot bill for services provided by your new provider if the health plan only allows credentialed clinicians to provide services and the new provider is not replacing anyone.
Even if the contract is under the practice's name, billing for services that were not provided by a credentialed clinician or by a credentialed substitute filling in for a previously credentialed provider would violate the health plan's contract. The health plan may only require physicians to be credentialed in some instances; in some plans, all providers physicians, and mid-levels are required to have credentials and be bound by the contract.
On the other hand, if the health plan does not require medical staff credentialing, you can bill new clinicians under the clinic name. In those cases, most health plans simply need a refreshed program of providers offering administrations under the center arrangement.
To bill Medicare, permanent full-time or part-time providers must be credentialed.
In the second scenario, when a provider leaves or is temporarily replaced, the answer is more difficult. Here are the billing options you can try.
A locum physician is a substitute physician who does not intend to join the urgent care practice but rather serves as a replacement. Only 60 days are allowed for locum physicians to practice and bill.
The Q6 modifier service provided by a locum physician is added to each CPT code on the claim when billing for locum physician services under the NPI of the doctor absent. It is not necessary to indicate the substitute services on the claim. The locum physician's NPI must be included in the record of patients seen by the practice. The locum physician receives the same fee-for-service or daily rate from the on-staff physician.
When an assignment is accepted, Medicare requires that an on-staff physician be able to bill and receive payment for the services of a substitute physician just like they were performed by the on-staff physician. Locum physician billing can also be used if an on-staff physician has left your practice and is unable to provide services. Each CPT code on the claim must also have the Q6 modifier added to it. Each locum physician has a 60-day consecutive limit, which begins with the first patient seen (even if patients aren't seen on certain days when a doctor is on vacation, has a day off, etc.).
If your practice's billing needs cannot be met with locum providers, don't give up hope. There are a few choices that can help you fill in the gaps while your providers get the right credentials. Here is the list:
Non-credentialed providers will keep on coming under scrutiny. Work with medical credentialing service agencies like ProLocums who can help in getting your doctors credentialed at the earliest. Make use of our expertise in medical credentialing service.
In healthcare, locum tenens is a term derived from the Latin phrase meaning “placeholder.” It refers to professionals hired to temporarily step in for another provider during their absence due to reasons such as illness, vacation, maternity leave, or continuing medical education. These professionals, often called “locums,” fulfill the same duties as regular providers, ensuring continuity of care for patients. However, there are important distinctions between locum tenens providers and temporary staff, especially regarding medical credentialing services.
Understanding these differences is crucial for healthcare organizations, as each category of provider is subject to different federal guidelines and requirements.
The primary distinction between locum tenens providers and temporary staff lies in their duration of service requirements.
While these terms are often used interchangeably, they are not synonymous when it comes to compliance and reimbursement. Organizations must carefully distinguish between the two to avoid administrative complications or delays in payment.
A locum tenens provider has several defining characteristics that set them apart from regular temporary staff. These include:
1. Traveling Clinician Role
Locums often work with one or more agencies, taking temporary placements in various geographic locations as needed. They typically do not maintain their own independent practices.
2. Specific Circumstances for Engagement
Locum tenens professionals are hired due to specific, temporary unavailability of the regular provider, such as medical leave or professional sabbaticals. They are not used to cover routine staff shortages or regularly scheduled time off.
3. Patient Service Flexibility
Locums may provide services beyond the regular provider’s office, ensuring continuity of care for the patients of the absent clinician.
4. Service Period Restrictions
Medicare guidelines specify that locum tenens professionals cannot provide services for more than 60 consecutive days for the same absent provider.
The documentation requirements for locum tenens providers are stringent, making it essential for health systems to adhere closely to federal guidelines.
1. Independent Contractor Status
Locum tenens professionals are considered independent contractors, not employees. They are typically compensated on a fixed per-day basis by the regular provider or the agency placing them.
2. Documentation Requirements
The regular provider must:
3. Special Cases for Post-Operative Care
Substitution services during the post-operative global fee period should not be identified as locum tenens services on claims.
4. Group Practice Exceptions
In group practices, if a locum tenens provider replaces a departing physician, they may be considered part of the group until a permanent replacement is hired. This is allowed as long as the locum’s services to Medicare patients do not exceed the 60-day limit.
If the circumstances of the provider’s employment fall outside the scope of the locum tenens guidelines, the substitute is classified as temporary staff. In such cases, they must undergo the full credentialing process of the host organization, including background checks, licensure verification, and payer enrollment.
Locum tenens providers are a valuable solution for healthcare systems facing temporary provider shortages. They ensure that patients continue receiving uninterrupted care while allowing organizations flexibility to address staffing challenges. However, adhering to the appropriate credentialing guidelines is critical to:
Navigating the complex rules of locum tenens and temporary staffing can be challenging. ProLocums offers credentialing verification services to assist healthcare organizations in managing locum tenens providers efficiently. From credentialing to payer enrollment and licensure applications, ProLocums ensures compliance and helps organizations meet their temporary staffing needs seamlessly.
By understanding and applying the correct rules for locum tenens providers, healthcare systems can make the most of this flexible staffing option while maintaining compliance and delivering high-quality patient care. For more details, visit Prolocums.com.
12/11/2024
If you’re a physician looking for flexibility and additional income without the commitment of a full-time position, locum work could be the perfect solution for your off days. Locum allows doctors to fill in at facilities experiencing physician shortages, offering supplemental pay and the freedom to set their own schedules. In this blog, we’ll explore why many physicians are opting for locum physician jobs, how these roles help doctors manage their time and careers more effectively, and how you can take advantage of this growing trend.
For physicians looking to avoid the pressures and long-term commitments of full-time practice, a locum job provides an ideal way to maintain a flexible work-life balance. Let’s dive into some of the key reasons why locum work is becoming so popular for physicians.
One of the greatest advantages of locum work is the scheduling flexibility it offers. Physicians can take on locum jobs during their off days from their regular practice or between more permanent commitments. You can choose when and where to work, allowing you to craft a schedule that works around your lifestyle.
This flexibility is especially beneficial for doctors looking to reduce burnout or avoid the rigidity of a traditional practice. If you’ve been feeling overworked or drained, locum work offers a change of pace, giving you the ability to work as much or as little as you want.
If you find that your current position is causing burnout or just need a change of scenery, locum jobs allow you to travel. You can work in different locations across the country, or even internationally, all while practicing medicine. This can be a great way to reignite your passion for your profession by experiencing new healthcare environments.
Locum physician job also provides opportunities to travel to desirable geographic locations. If you’ve always wanted to explore new cities or regions, why not get paid while doing so? With positions available nationwide, you can choose where you work, whether you prefer staying closer to home or traveling to new and exciting places.
One of the most immediate financial benefits of locum work is the opportunity to earn extra income. Whether you’re paying off student loans, managing debt from opening your own practice, or looking to boost your savings, a locum job can provide a reliable stream of additional revenue.
Doctors can adjust the amount of work they take on, depending on their financial goals. If you need to make a significant dent in your student loans or other debt, you can increase your locum hours.
Working as a locum physician gives you the unique opportunity to experience a variety of healthcare settings. This exposure helps you improve and diversify your skills. You’ll get to work in different specialties, practice in diverse clinical environments, and collaborate with various medical teams, each offering new learning experiences.
Moreover, locum doctor jobs allow you to try out different healthcare facilities before deciding on a permanent job. This can help you find the ideal work environment and refine your preferences when it comes to patient care, work culture, and medical specialties.
Finding the right locum job is crucial for maximizing the benefits of this career option. Working with a reputable medical staffing agency can streamline the process, making it easier to match with positions that align with your skills, preferences, and schedule. These agencies maintain extensive databases of available locum jobs, and they can help you find opportunities that best fit your lifestyle.
By working with a staffing agency like ProLocums, you can save time and effort searching for positions, and you’ll benefit from expert guidance in navigating the locum job market. Whether you’re interested in staying close to home or using your schedule to travel, there are countless opportunities available to you.
Locum positions are an excellent option for physicians seeking flexibility, additional income, and the opportunity to explore new environments. Whether you're looking to pay off debt, improve your skills, or reduce burnout, locum jobs allow you to create a fulfilling and balanced career. By finding the right placement and managing your schedule wisely, you can enjoy the benefits of locum jobs while maintaining a positive work-life balance.
If you’re considering taking on locum work, get in touch with a trusted staffing agency like ProLocums to help you find the perfect position for your needs.
11/19/2024
Finding skilled physicians to address your staffing needs can often be a challenging process. Whether you’re dealing with a temporary vacancy, a seasonal influx of patients, or a persistent staff shortage, hiring locum tenens physicians can provide an efficient and beneficial solution.
Locum tenens physicians work on a temporary or contract basis across multiple healthcare settings. Their role is crucial in maintaining continuous patient care, alleviating the workload of your permanent staff, and bringing new expertise and fresh perspectives to your team.
According to the 2023 State of Locum Tenens Report, experts forecast steady growth in the locum tenens market, driven by clinician shortages and the need to catch up on treatments deferred during the COVID-19 pandemic. In fact, the locum tenens staffing segment, valued at $22.5 billion in 2022, is projected to grow at an annual rate of 5.7% from 2023 through 2030.
Bringing locum tenens physicians into your healthcare organization offers numerous advantages including flexibility, high standards, and cost efficiency.
However, hiring locum tenens physicians comes with its own set of challenges, especially when it comes to credentialing. Understanding and efficiently managing the credentialing process is key to ensuring a smooth and successful hire.
Credentialing is the process of verifying a physician’s identity, qualifications, and competence before they are allowed to practice at a healthcare facility. This step is vital for maintaining high standards of care, protecting patient safety, and ensuring compliance with regulatory requirements.
When hiring locum tenens physicians, the process of medical credentialing service typically involves two stages. First, the locum tenens agency like ProLocums conducts internal credentialing to ensure the physician meets general standards. Then, the healthcare facility where the physician will be working completes external credentialing specific to the job.
The credentialing timeline can vary, often taking anywhere from a few weeks to several months, depending on the complexity and urgency of the case. Delays in credentialing can be particularly challenging for healthcare facilities facing an immediate staffing shortage. Streamlining this process, even slightly, can result in significant improvements to your facility’s operational efficiency and return on investment (ROI).
Before you begin your search for locum tenens physicians, it’s important to ensure that your facility is ready to integrate them smoothly.
Clearly define your immediate and future staffing requirements, including the specialization, skills, and experience. Determine a realistic budget for hiring locum tenens physicians, considering factors such as travel, accommodation, malpractice insurance, and agency fees.
Partnering with a reputable locum tenens agency like ProLocums that specializes in your area and has experience with your location is crucial. Conduct thorough interviews to evaluate each candidate’s qualifications and compatibility with your facility’s culture. Always check references and verify credentials before making a final decision. Choose the candidate who aligns most closely with your needs and expectations.
Once you’ve selected the right physician, it’s time to initiate the credentialing process. Key steps include:
While credentialing is an essential part of the hiring process, it can be time-consuming and complex. Technology solutions like ProLocums can simplify and expedite credentialing. By automating manual tasks, ProLocums can dramatically shorten the credentialing timeline with real-time status updates and easy access to credentials, which can enhance the overall experience for both physicians and healthcare facilities.
In summary, onboarding locum tenens physicians can be a strategic solution for addressing staffing challenges in healthcare. By preparing your facility, carefully selecting candidates, and streamlining the credentialing process, you can ensure that locum tenens physicians are seamlessly integrated into your team and contribute to the delivery of high-quality patient care. For more information visit Prolocums.com
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