Locum Tenens

Does a locum tenens have to be enrolled in Medicare to provide services to Medicare patients? Are there any specific citations by CMS addressing this?

Locum

A locum tenens physician must be a credentialed Medicare provider (other than for your practice), and a record of that physician's National Provider Identifier should be on file with the carrier. Locum physicians should not have a practice of their own. The services must be billed using the modifier –Q6 to show that it is a locum tenens physician, and a record of the services provided to your patients by the locum tenens physician must be kept. Any physician treating Medicare patients, and whose services are billed to Medicare, must be a Medicare provider.

Locum tenens

Is there a citation that states the LOCUM TENENS PHYSICIAN must be a Medicare provider? The specific information for the locum does not go on the claim to Medicare, only modifier -Q6.

Locum

http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf
30.2.11 - Physician Payment Under Locum Tenens Arrangements - Claims Submitted to Carriers
(Rev. 1486, Issued: 04-04-08, Effective: 01-01-08, Implementation: 05-05-08)
A. Background
It is a longstanding and widespread practice for physicians to retain substitute physicians to take over their professional practices when the regular physicians are absent for reasons such as illness, pregnancy, vacation, or continuing medical education, and for the regular physician to bill and receive payment for the substitute physician’s services as though he/she performed them. The substitute physician generally has no practice of his/her own and moves from area to area as needed. The regular physician generally pays the substitute physician a fixed amount per diem, with the substitute physician having the status of an independent contractor rather than of an employee. These substitute physicians are generally called “locum tenens” physicians.
Section 125(b) of the Social Security Act Amendments of 1994 makes this procedure available on a permanent basis. Thus, beginning January 1, 1995, a regular physician may bill for the services of a locum tenens physicians. A regular physician is the physician that is normally scheduled to see a patient. Thus, a regular physician may include physician specialists (such as a cardiologist, oncologist, urologist, etc.).
B. Payment Procedure
A patient’s regular physician may submit the claim, and (if assignment is accepted) receive the Part B payment, for covered visit services (including emergency visits and related services) of a locum tenens physician who is not an employee of the regular physician and whose services for patients of the regular physician are not restricted to the regular physician’s offices, if:
The regular physician is unavailable to provide the visit services;
The Medicare beneficiary has arranged or seeks to receive the visit services from the regular physician;
The regular physician pays the locum tenens for his/her services on a per diem or similar fee-for-time basis;
The substitute physician does not provide the visit services to Medicare patients over a continuous period of longer than 60 days subject to the exception noted below; and
The regular physician identifies the services as substitute physician services meeting the requirements of this section by entering HCPCS code modifier Q6 (service furnished by a locum tenens physician) after the procedure code. When Form CMS-1500 is next revised, provision will be made to identify the substitute physician by entering his/her unique physician identification number (UPIN) or NPI when required to the carrier upon request.