AmeriHealth requires all physicians who provide services to our members to be credentialed and contracted. However, under certain circumstances, we do allow for locum tenens arrangements.

What is a locum tenens arrangement?

Substitute physicians are generally called locum tenens physicians. According to the Medicare Claims Processing Manual, it is a long-standing and widespread practice for physicians to retain locum tenens physicians in their professional practices when they are absent for reasons of illness, pregnancy, vacation, or continuing medical education.

It is also acceptable for the regular physician to bill and receive payment for the locum tenens physician?s services as if he performed them himself. The locum tenens physician generally has no practice of his own and moves from area to area as needed. It is customary for the regular physician to pay the locum tenens physician a fixed amount per diem.

Locum tenens status is that of independent contractor rather than an employee. In addition, locum tenens provisions apply only to physicians. Services of non-physician practitioners (e.g., Certified Registered Nurse Anesthetists, Nurse Practitioners, and Physician Assistants) may not be billed under the locum tenens guidelines from the Centers for Medicare & Medicaid Services. These provisions apply only to physicians.

Duration of a locum tenens arrangement

If a regular physician is absent longer than 60 days without returning to work, the locum tenens must be credentialed and enrolled as if he or she were joining your practice as a new physician.

The 60 days is a "consecutive" 60-day period. For example, a locum tenens physician providing coverage three days a week beginning on September 1 can still only provide services for the same absentee physician through October 30. This also applies even if several different locum tenens physicians are used to provide coverage during the 60-day period, because the limitation is tied to the billing of the Q6 modifier, not to the number of days that any particular locum tenens physician provides coverage.

Therefore, a new 60-day period for billing the services of a locum tenens physician does not commence as a result of a break in service of the locum tenens physician. Instead, a new 60-day period commences only by a break in the absence of the physician for whom a locum tenens physician is necessary. After the regular physician returns to work and provides services for at least one day, then a locum tenens physician can provide services as a substitute for that regular physician again at some point in the future, if necessary, for up to 60 consecutive days.