cigna locum tenens policy

If the physician has left the practice, every claim still must have a rendering provider, so the practice would still use his or her name and NPI with modifier Q6 Services furnished by a locum tenens physician appended to the procedure code to indicate the service was furnished by an interim physician. 739 0 obj <> endobj This decision would be made as a part of our case management process, which is an integral part of all Cigna health plans. We oppose the use of financial incentives that encourage physicians to withhold necessary care. Within this article there is a statementDo not bill for services provided by locum tenens while waiting for a physician to be credentialed with Medicare. Cigna coverage policies are tools to assist in interpreting standard health coverage plan provisions. If the physician is hired, the practice should submit the enrollment forms and wait for enrollment to be completed. Customers and health care professionals with preventive health guidelines for women, men, and children. Training our customer service staff to assist in getting or giving written or spoken information in your preferred language. Legislators are attempting to guarantee that consumers are offered a health care coverage option other than a traditional HMO.We oppose legislative mandates that would require all HMOs to offer an out-of-network benefit. Physicians are eligible for a bonus at the end of the year based on quality of care, quality of service, and appropriate use of medical services. Locum tenens physicians may not bill Medicare; they should be paid on a per diem or similar fee-for-time basis. Changes to the Payment Policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements) Implementation Date. Mental health advocates are now seeking state legislative mandates that would require mental health coverage be provided in all health plans at the same level of benefits as physical illness. What if a locum is covering a provider and then the provider retires, how do we continue to bill and collect for the locum. program, available to expectant participants in our Network, POS, EPO, and PPO plans, provides educational support to help participants have a healthy pregnancy and baby. We are wondering about bringing in a locum to cover the remainder of the leave. Learn more about ourprior authorization procedures. Does that mean that the locum can only bill under the other provider for basically 2 months, then needs to do his own billing paperwork? Any hour of the day or night, from any phone in the U.S., you can call toll-free to speak with a registered nurse about your symptoms and situation. All insurance policies and group benefit plans contain exclusions and limitations. The most up to date and comprehensive information about ourstandard coverage policies are available onCignaforHCP, without logging in, for your convenience. So we wouldnt be billing incident to we would be billing Locum Tenens for a non-employed Physician. noun. Are you to bill under the physician that has left- as the patients the LT is seeing is the old physicians or are you to bill under s current physician in the practice? You can generate more revenue for your facility by consistently enrolling locums with payors and billing for their services. Our members cannot make sound, sensible decisions if they have been given inadequate or incomplete information. Leverage these game-changing resources to drive your business forward and protect your bottom line. Can the Locum continue to provide services while the practicing physician is on vacation (for the 60 days), while we are in the process of credentialing with an effective start date in 3 months? Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see These drugs are placed on the formulary by the Cigna Pharmacy and Therapeutic Committee, which meets quarterly and is composed of physicians and pharmacists.The Cigna Pharmacy and Therapeutic Committee reviews all FDA-approved drugs, groups them by therapeutic function, and then, within each group, compares their relative therapeutic effectiveness and potential side effects. The study is flawed in several ways, the most important of which is that it does not establish any baseline for results (for example, it does not look at drug costs and drug/medical utilization patterns at the HMOs studied prior to the effective date of the formularies).The Cigna formularya list of drugs covered by a member's benefit planwas developed to assure quality and cost effective drug therapy. Radiation Oncology (CMS Pub. The Q6 modifier must also be added to each CPT code on the claim. The terms of your plan will tell you what benefits you are eligible for. It involves having health care professionals review tests and procedures that your provider orders to determine if your Cigna plan will cover the cost. Hi everyone. In certain instances, this practice is considered to be experimental.We do not prohibit off-label use of approved medications, but use of certain drugs does require preauthorization. If neither locum tenens nor reciprocal billing arrangements are a solution for your practices billing needs, dont lose heart. Locum physicians may only practice and bill for 60 days. Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. The locum tenens physician can only be utilized up to a 60-day continuous period, and, if needed, another physician can be brought in for up to another 60 day period (not more than two periods 120 days total) The regular physician must be unavailable. Our Three-Tier Formulary covers generics, preferred-brand, and non-preferred brand drugs (medications that have generic equivalents or one or more preferred-brand options available at a higher copayment level). These sources include federal or state coverage mandates, the group or individuals benefit plan documents, internally developed coverage guidelines, and industry-accepted guidelines such as MCG and ASAM. Theyll look to see what benefits your plan covers. Requests for coverage for off-label drug use are reviewed on a case-by-case basis. Our Utilization and Case Management services have been awarded accreditation from URAC, an independent, not-for-profit organization whose mission is to ensure consistent quality of care for clients and customers. Home care nurses are trained to give a full assessment of the mother's and baby's health as well as answer any questions. We understand 60 days and Q6 but what about the EHR documentation? The dental community has traditionally used these guidelines as part of the utilization management decision-making process. 2017. The locum tenens provision is widely used, but often misunderstood, which puts practices at risk if the guidelines are not followed. If you need a lot of dental work done, and are concerned about whether your plan will cover it, Cigna will review the treatment plan if you ask us. A locum tenens physician cannot be used to cover expansion or growth in a practice. Go directly to the nearest emergency facility or notify your local emergency services immediately. Researching and implementing the policies of other insurance carriers is the next step in making sure your office has compliant documentation in patient's charts as well as other documentation carriers may require. One of the biggest concerns with mandated benefits is that they increase the cost of health care coverage. A clinic may need to fill a role quickly due to the unexpected loss of a provider (i.e. Remember that this is not a call for authorization to seek emergency care. Our locum is here and the provider has left the practice. All competitors should have to meet the same regulatory requirements. This type of reimbursement encourages overtreatment which, in addition to being expensive, can be dangerous. If you do not know what is required by a specificpayer, again, it is a good rule of thumb to follow Medicare policy. We believe that the marketplace should determine the benefits available to health plan participants. BLOG: Learn what should be included in your billing SOP for a healthier RCM >>. Individuals involved in utilization management and the review process include Cigna employees in the Clinical, Quality Management, and Claim departments. Some of the alternative therapies of interest include acupuncture, naturopathy, biofeedback, and massage therapy. Financial Incentives/Provider ReimbursementThe manner in which health plans reimburse providers is another issue that is coming under increased public scrutiny. 2/ 2022 A locum tenens physician who is expected to work 30 or more continuous days is required to meet the two (2) hours of CE requires for new healthcare providers. If you need specialty care, your primary care dentist will give you a referral. This helps save you money so you're not paying for unnecessary care.How does the Cigna dental team decide what my plan covers and whether a treatment is medically necessary?Dental professionals make coverage decisions using the terms of your dental plan. You do not need to get pre-authorization for dental procedures. Continuity of care can be accomplished by allowing the member to continue to receive treatment from the current non-participating provider or working to affect the smooth transition of care to a Cigna-participating provider. Medically necessary inpatient care is also covered. It has resurfaced again in several state legislatures and at the federal level. Publication # 100-04. Changes to the Payment Policies for Reciprocal Billing Arrangements and Prior authorization is a request for coverage of a health care service or treatment that requires clinical review. What is locum tenens | A definition of locum tenens - Weatherby Blog Locum physician services can be billed under the NPI of the doctor absent, with the Q6 modifier (service provided by a locum physician) added to each CPT code on the claim. The use of locum tenen provider has been expanded to 180 days during the COVID-19 emergency. The relationship Cigna members establish with their PCP facilitates better use of specialty services. Health plan medical directors use utilization management guidelines to assist in making such coverage determinations, but they are used as just thatguidelinesand are not a substitute for a clinician's judgment. Health Plan Liability/Medical Director LiabilityThe issue of health plan liability for medical decisions first surfaced in the debate over the health care reform legislation during the Clinton presidency.