Payment and Billing: Where Locum Tenens Can Become a Nightmare


Most of what you read about locum tenens is written from the perspective of providers and staffing agencies. Very little is written about those who pay the bill: employers. Yet locum staffing affects payers in profound ways. Paying providers and billing for reimbursement is where locum tenens can become a real nightmare.

A healthcare vendor management system that includes an integrated payment and billing module can go a long way toward making things run smoothly. When that kind of software is combined with healthcare management services from an MSP provider, things get even easier.

What does this suggest? That hospitals and healthcare systems would do well to start looking for technology-based solutions to solve their payment and billing problems. The right technology solves a lot of problems before they even occur.

The 60-Day Rule for Medicare

Every locum tenens scenario involves both a payment and a bill. Employers pay locum tenens for their services either directly or through their staffing agencies. Then they turn around and generate a bill for reimbursement. Here’s where the fun starts.

Your typical health system begins by applying the 60-day rule for Medicare. The rule states that locum providers are only allowed to provide care to Medicare patients for a maximum of 60 consecutive days. The one exception is when a patient’s primary doctor is away for active military service.

Health systems start with this rule because they need to know how it is going to affect billing. If they know that an open locum assignment will be for 60 days or less, they do not have to worry about the rule. They can bill Medicare, Medicaid, or commercial insurance providers at will. Of course, they will have to touch base with those commercial providers first.

When Longer Assignments Are Required

Facilities faced with a pending locum assignment in excess of 60 days would have to figure out another way to deal with Medicare reimbursements. The simplest and easiest solution is to split up the assignment into two smaller chunks of time. Put a week or two between them and bring in another locum for the short duration. When the original locum returns, the 60-day period resets.

Some facilities do not like the prospect of splitting up longer assignments. In such cases, there is another option: enroll the provider in the facility’s contracted payer mix. In other words, the doctor can be used to provide care to both government and commercially insured patients rather than just Medicare patients alone.

How does this help? By allowing the facility to claim reimbursement using the provider’s NPI number. They are essentially treating the provider as a permanent employee for reimbursement purposes following the conclusion of the 60-day Medicare limit.

Keeping Track of It All

Discussing the 60-day rule brings us back to the topic of a vendor management software solution. A good vendor management system includes integrated payment and billing modules for keeping track of this sort of thing without having to rely on separate software.

Utilizing such a solution accomplishes a couple of things. First of all, it makes managing payments and reimbursements easier by keeping all of the information in a central location. Second, a centralized tool offers quick and easy access to the data decision-makers need. They can glean historical locum tenens data and use it to protect future needs.

Payments and billing can make utilizing locum tenens staffing unpleasant. But it doesn’t have to. With a good vendor management system and a basic understanding of the 60-day Medicare rule, it is possible to manage payments and reimbursements with ease.