Are you billing all you can for locum tenens physicians?

The demand for locum tenens physicians has increased significantly over the past several years. Today, they are helping to meettemporary physician staffing needs in hospitals, group practices and clinics around the country.

In addition to being able to fill in for regular physicians when needed, there are plenty of other benefits associated with using locum tenens physicians. For example, significant cost savings can be achieved by not having to employ additional full time physicians, while administrative functions, like malpractice coverage,become the responsibility of the locum tenens group. While the benefits of utilizing locum tenens physicians are plenty, when not managed properly, there are also some risks including the potential for lost revenue.

Physician Enrollment

When utilizing the services of a locum tenens physician, it is common practice to link them to Medicare and Medicaid and forego pursuing enrollment with private carriers. The reason, from a government perspective it is very easy to enroll locum tenens. Enrolling themwith commercial carriers, however, requires significantly more work.

Alocum tenens physician’s specialty can impact a provider’s enrollment chances with a commercial carrier. Ifthere is an overflow in the area of the number of providers for a particular specialty, it is unlikely the carrier will approve enrollment. Additionally, becauselocum tenens don’t have regular office hours, typically they work only a few hours every month, it is not uncommon for health plans to initiallydecline the enrollment simply because it isn’t worth their time and effort to enroll the provider. Both of these instances can result in significant back and forth. In the meantime, without a reliable way to track a locum tenens physician’s enrollment status, hospitals, group practices and clinics run the risk of booking the providerunder a plan they are not enrolled with which means the provider cannot bill for services. Overtime, lost revenue from having to write off a case can be significant.

The Role of Technology

Without technology in place it is very difficult to keep track provider enrollment, this is especially true when dealing with locum tenens who work infrequent hours. Expecting schedulers to rely on notes or some type of a shared grid that too many people have access to means information is not always current.

Replacing outdated manual tracking methods with cloud-based provider enrollment technology ensures front office staff have instant access to the most current information. With just a few clicks on the keyboard, they can see what payers each provider is listed with as appointments are being scheduled. If a locum tenant only participates in Medicare/Medicaid, they will only be booked with patients under this plan.

While the financial implications of having to write off an encounter are well known, it is surprising that many practices are overlooking a process equally as important as insurance verification – provider enrollment verification. Similar to a patient not having valid insurance, when a provider is not properly enrolled with a health plan, his/her encounters will be written off. Yet few practices have processes in placefor provider enrollment verificationthat are as stringent as insurance verification.

When adding locum tenens to the mix, the task of managing provider enrollment is that much harder. Fortunately, advances in technology are making it easier to ensure patients are scheduled with the correct provider so that hospitals, group practices and clinics are billing all that they can for physicians, locum tenens included.

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