Even doctors get sick sometimes, or need to take a vacation, and when they do, patients are not seen and billing does not happen. Cue locum tenens – a system used by providers to ensure continuity of care and revenue when providers need to complete continuing medical education requirements or take time off for vacations or medical or maternity leave.
Locum tenens practitioners are substitute providers that are paid by the regular provider on a per diem or other fee-for-time basis. The Centers for Medicare and Medicaid Services (CMS) allows the regular provider to bill Medicare for services covered by the locum tenens provider if: (1) the regular provider is unavailable; (2) the patient has arranged the services of the regular provider; (3) the regular provider pays the locum tenens provider for his/her services on a per diem or similar fee-for-time basis; (4) the locum tenens provider does not provide services over a continuous period of longer than 60 days, unless the regular provider is called to active duty as a member of a reserve component of the Armed Forces; and (5) the regular provider identifies the services when billing with the appropriate billing modifier.
To cover absent providers, CMS also allows certain providers to engage in reciprocal billing arrangements. These arrangements are informal relationships between providers, whereby each provider agrees to cover the other provider’s practice when the other provider is absent.
Last month, CMS released Change Request 10090 (Change Request) which implemented section 16006 of the 21st Century Cures Act and allows Medicare-enrolled physical therapists to utilize these arrangements in certain geographic areas. As a result of CMS’s Change Request, effective June 13, 2017, Medicare-enrolled physical therapists can use locum tenens and reciprocal billing systems to furnish outpatient physical therapy services in a Health Professional Shortage Area (HPSA), a Medically Underserved Area (MUA), or a rural area, as defined by the Department of Health and Human Services.
However, these new arrangements ditch the “locum tenens” name. The term “locum tenens,” which translates to “to hold a place,” will be replaced with the term “fee-for-time compensation arrangements.” As explained by CMS in its Change Request, CMS elected to discontinue use of the term because the “21st Century Cures Act uses ‘locum tenens arrangements’ to refer to both fee-for-time compensation arrangements and reciprocal billing arrangements…[and] [a]s a result, continuing to use the term ‘locum tenens’ to refer solely to fee-for-time compensation arrangements is not consistent with the law and could be confusing to the public.”
Expanding the availability of these arrangements represents a hard-fought victory for organizations like the American Physical Therapy Association, which has long supported allowing physical therapists to engage in fee-for-time compensation and reciprocal billing arrangements. Although the new rules only allow such arrangements in specified areas, they will provide relief to providers in the designated areas and help to ensure access to high-quality care for Medicare beneficiaries.
To read the CMS Change Request, click here.For more information from HHS on HSPAs and MUAs please visit: https://datawarehouse.hrsa.gov/topics/shortageAreas.aspx