You can still get paid while on vacation
Medicare allows substitute billing
Here’s a new twist on the idea of a paid vacation: Get Medicare to reimburse you for having a colleague see your patients while you are away from the office on vacation. Sound too good to be true? According to Kent Moore, a reimbursement expert with the American Academy of Family Physicians in Leawood, KS, here’s how it works. "You may submit claims and receive payments from Medicare for covered visit services, including emergency visits and related services, that you arrange to be provided by a substitute physician on an occasional, reciprocal basis," says Moore.
For this to happen, however, you must meet the following four requirements:
1. You must be unavailable to provide the visit services.
2. Medicare patients must have arranged to receive or seek to receive the visit services from you.
3. Substitute physicians must not provide the visit services to Medicare patients over a continuous period of more than 60 days.
4. You must submit the claim using your unique physician identification number (UPIN) and attach a -Q5 modifier to the procedure code. Also be sure to cross-reference the entry to the appropriate service line item.
"Naturally, if you are in a group practice where claims are submitted in the name of the group, then reciprocal billing does not apply to you," he notes. However, if you are a member of a group whose physicians bill in their own names, then Medicare treats you as an independent physician, and the rules regarding reciprocal billing arrangements apply.
As with any claim, proper and complete documentation is key to getting paid. In the case of a substitute physician:
• Maintain a record of each service provided by the substitute physician, including a reference to the substitute physician’s UPIN. This file should be made available to your Medicare carrier upon request.
• Remember that reciprocal arrangements don’t have to be in writing, and you may have arrangements with more than one physician. All reciprocal arrangement requirements are the same for assigned and unassigned claims.
• If the only substitute services a physician performs in connection with an operation are postoperative services furnished during the period covered by the global fee, you generally don’t have to identify them on the claim as substitution services.
When it comes to locum tenens, "the requirements for claiming payment for locum tenens services are almost the same as those for reciprocal billing arrangements," observes Moore. The only differences are that you have to use a -Q6 modifier, and you must pay the locum tenens physician on a per diem or fee-for-time basis. Remember: Locum tenens physicians cannot be your employees, and their patient services cannot be restricted to your office.
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