Can a Nurse Practitioner Take a Locum Tenens Position?

Carolyn Buppert, MSN, JD


February 19, 2019

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A nurse practitioner (NP) asked whether it was appropriate to accept a locum tenens position for a physician taking an extended leave.

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

Locum tenens is a Latin phrase that means "to hold the place of, to substitute for." Sometimes, practices and facilities will want an NP to fill in for a physician who is out on maternity, sick, continuing education, vacation, sabbatical, or military leave. There is one reason, from a legal standpoint, why an NP may not be the best choice of provider to fill in for a physician who is away: Medicare's rules on locum tenens, which allow a substitute's professional services to be billed under the name of the regular physician, apply to physicians. There is no mention of NPs, although the rules do apply to physical therapists.

Medicare now calls locum tenens "fee-for-time compensation arrangements." The rules on fee-for-time compensation arrangements, found in the Medicare Claims Processing Manual, Chapter 1, section 30.2.11, say that if a substitute physician is holding the place of a physician who is returning within 60 days, the practice may bill for professional fees using the absent physician's billing information, as long as the following conditions are met:

  • The regular physician is unavailable to provide the visit services.

  • The patient has arranged or seeks to receive the visit services from the regular physician.

  • The regular physician pays the substitute on a per diem or similar fee-for-time basis.

  • The substitute physician does not provide services to Medicare patients over a continuous period of longer than 60 days. Extended time is allowed when a physician is on leave to serve in the military.

  • The regular physician indicates that the services were provided by a substitute physician under a fee-for-time compensation arrangement meeting the requirements of this section by entering HCPCS code modifier Q6 (service furnished under a fee-for-time compensation arrangement by a substitute physician in a health professional shortage area, a medically underserved area, or a rural area) after the procedure code.

  • If a practice wants an NP to fill in for a physician who is away, the practice will need to go through Medicare's regular credentialing process and cannot bill the NP's services under the regular physician's name and number. Other payers may have their own rules.

  • If a physician is going to be gone for more than 60 days, Medicare wants the substitute, whether a physician or NP, to be credentialed through the usual credentialing process.

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