Reimbursement Tips: Getting the Most for Locums Work

It’s actually a common problem. From my work, I estimate between 30-40 percent of organizations that utilize locum tenens clinicians don’t understand how to properly enroll their locums providers in order to receive reimbursement for their services.

At the heart of the issue is the answer to a simple question. Can I receive reimbursements for locum tenens providers? While the answer may obviously seem to be yes, it’s not as simple as it seems. There are two ways to receive payment for locums work. I like to think of it as a fork in the road.

Short term—This is the simplest way. If a physician is on leave for 60 days or less, you can file a Q6 Modifier which allows the locums clinician to bill under the permanent clinician’s enrollment. But this is rarely the case in today’s world. Often clinicians are staying at locums assignments for a year or more, meaning that we need another solution.

Long term—A clinician does not have to be a permanent employee to be enrolled as a provider at a facility. You can have 1099 contractors who are enrolled as providers, which accounts for most locum tenens clinicians. This is only for enrollment terms.  This option is a more labor-intensive path to receive reimbursements and it takes longer, but it allows you to receive full payment for the care provided. This is also the path that would need to be utilized for any Advanced Practice Practitioners.

Here are  some additional tips to ensure you are getting the most from your locums clinicians:

Start the conversation early

A little planning on the front end can save you headache later. By starting the enrollment conversation with the locums clinician early and getting on the front side of the application, you will put the organization in a good position to maximize reimbursements, instead of scrambling to find clinician information after their assignment has completed.

Follow up on the application

You can’t expedite the process, but you can follow up on the enrollment application to make sure it is progressing through the system. On the federal side, it should take 1-2 months, but there can be hold ups or an application can get lost. I’ve seen an application lay dormant for seven months which is devastating financially when you are expecting to bill in the realm of $10,122 per day. Simple follow up will make sure the application is on the right path and you will get paid in a timely manner.

Use back billing to your advantage

Each state is different when it comes to billing and enrollment. Back billing is about timing and understanding regulations around effective date (the first day you can bill for a clinician). For instance, Medicare allows the effective date to be 30 days before submission of the enrollment application. For Medicaid in Georgia, the effective date can be the first day of the month in which you are submitting. Ideally, you want the effective date to be as early as possible and to align with the clinician’s start date. Each state and situation is unique, so it may be helpful to have an expert help to ensure you are maximizing back billing.

Use a resource

Reimbursements can be complicated. My job is to help healthcare organizations maximize their reimbursements by optimizing their enrollment process. I’ve seen it all and created roadmaps that can help organizations maximize their earning potential. It’s an invaluable tool that more organizations should take advantage of because it can have a large impact on the bottom line.

There is so much potential for healthcare reimbursement. Every day I see hospitals and medical practices leave money on the table because of an incomplete understanding of the regulations around locum tenens clinicians. Maximizing your ability to bill for the care you provide can have a huge impact on the finances of an organization and set you up for long-term success.

If you have questions, please reach out to us. We’re here to help.