Highmark to Change Locum Tenens Policy as of June 1, 2018

Last Updated: May 1, 2018

doc-patient12-articleHighmark is updating its locum tenens policy which allows a practitioner to cover for another practitioner when they are absent for reasons of illness, retirement, death, medical leave, vacation, military leave, or continuing medical education.

Effective June 1, 2018, Highmark will no longer accept locum tenens forms. To indicate that services were provided by a substitute physician under a fee-for-time compensation arrangement, you will be required to use HCPCS code modifier Q6 after the procedure code.

A physician may submit a claim to Highmark and – if the locum tenens assignment is accepted – receive payment for covered visit services of a substitute physician if:

  • The regular physician is unable to provide the services.
  • The Highmark member has arranged or seeks to receive the services from the regular physician.
  • The regular physician pays the substitute for his/her services on a per diem or similar fee-for-time basis.
  • The substitute physician does not provide the services to patients over a continuous period of longer than 60 days subject to the following exception:
    • A physician called to active duty in the Armed Forces may bill for services furnished under a fee-for-time compensation arrangement for longer than the 60-day limit.

Highmark says that modifier Q6 is not required if the only services a substitute physician performs in connection with an operation are post-operative services furnished during the period covered by the global fee.

In this Provider News update regarding the policy change, Highmark notes that claims submitted with a Q6 modifier will be subject to ongoing monitoring and audit for fraudulent billing activity.

Pennsylvania Medical Society (PAMED) members with questions on this issue or other Practice Support topics can contact PAMED’s Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

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