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Bust 3 Myths to Boost Pay for Your Fee-for-Compensation Physicians

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Bust 3 Myths to Boost Pay for Your Fee-for-Compensation Physicians

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Fee-for-compensation

Are you billing for fee-for-compensation services correctly? Many practices aren’t — and that means leaving money on the table. In today’s healthcare market, that’s not something you can afford to do.

Unfortunately, fee-for-compensation billing is often misunderstood, so many practices aren’t getting all the reimbursement they deserve. Plus, incorrect or non-compliant billing practices can catch the eye of auditors who could investigate every corner of your practice.

Also known as “locum tenens” or “reciprocal billing arrangements,” fee-for-compensation billing is an important part of improving your reimbursement and keeping your practice off auditors’ radar. Keep reading to find out the truth behind three persistent myths about this type of billing.

1. Billing Fee-for-Compensation Services Is Too Complex

Many practices assume that billing for contracted providers is so difficult and confusing that they simply write off the expense. But those costs can be recovered and are typically well above the daily rate that a fee-for-compensation physician will cost you. To reap every reimbursement dollar you’ve earned, you should be billing Medicare for services provided by fee-for-compensation physicians. And it’s not that difficult. Here’s how:

  • You can bill for fee-for-compensation coverage for a regular physician who is unavailable for a limited period (such as for a vacation, or continuing education), as long as the patients seek to receive the services from the regular physician.
  • You can bill for fee-for-compensation services for a continuous period of no more than 60 days. The 60-day count begins on the day that the fee-for-compensation physician sees their first patient — not the day that the regular physician takes their absence.
  • On the Medicare claim form, bill under the regular physician’s NPI. Also, be sure to append modifier Q6 to the procedure codes you’re billing.

Keep in mind that these guidelines are for billing Medicare only. Medicaid and other insurers may or may not allow you to bill for fee-for-compensation services. You’ll have to contact your payers for verification.

2. Hire a New Fee-for-Compensation MD to Restart a Count

When the continuous 60-day period runs out, you may not hire a different fee-for-compensation physician and start the process over. But you do have the following options:

  • You can immediately credential the physician with Medicare as if she is new to your practice.
  • You can bill the contracted physician’s services under her NPI as if she is a permanent physician.
  • The absent provider can return for a brief period. If so, the 60-day count will restart. You could then continue using the same fee-for-compensation physician for another 60-day period, or hire a new one.

Tip: The fee-for-compensation physician does not have to be enrolled in Medicare to cover for another physician, nor must she be in the same specialty.

3. Fee-for-Compensation Billing = Incident-To Billing

Often confused with fee-for-compensation billing, incident-to billing differs in an important way: the staff rendering the incident-to service is not billing under her NPI but under another provider’s NPI. Also, when a contracted physician is providing services, the regular physician is absent. In order to bill a service “incident-to,” the billing physician must physically be in the office when the service is taking place.

Regardless if you are billing fee-for-compensation or incident-to, billing under another provider’s NPI can be risky if you don’t follow the rules. Failing to meet all of the requirements for both fee-for-compensation and incident-to billing could result in major financial penalties under the False Claims Act.

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