Your physician goes out on leave, you bring in a covering doctor, and the claims go out under the absent physician's NPI. Everything seems fine. Then, months later, an audit notice arrives: the claims went out under the wrong NPI, without the right modifier, or past the time limit. Those claims can be pulled back. In this solo episode, Dr. Heather Signorelli walks practice owners, managers and billing teams through locum tenens billing: what the Q6 modifier tells the payer, how the 60-day rule works, and why a new hire waiting on credentialing is never a locum situation. FREE METRICS AUDIT REVIEW redacted... Send us your monthly numbers and Dr. Signorelli personally reviews them, with a read on what the pattern is saying and where we would look first. If a change isn't needed, we'll tell you. FREE BILLING PERFORMANCE SCORECARD redacted... Enter six numbers from the system you already use and each one turns green, yellow or red, with a one-page 90-day action plan. IN THIS EPISODE • What locum tenens billing is, and why temporary is the key word • What the Q6 modifier tells the payer, and how a locum claim is built • How the 60-day rule works, and when the covering physician needs their own Medicare enrollment • Why Q6 never applies to a new physician waiting on credentialing • Your real options when a new hire starts before credentialing is complete • The written agreement and records your billing team needs • Why commercial payers may not follow Medicare's rules THE LOCUM CHECKLIST A written agreement with the covering physician or their agency • The arrangement's start date: day one is the first patient the substitute sees • A day 45 internal flag to decide whether coverage ends or enrollment starts • A 60-day hard stop • The substitute's name and NPI documented in every record • Q6 on every locum claim, billed under the absent physician's NPI • Documentation of the regular physician's absence and the reason for it • A check of each commercial payer's policy before billing non-Medicare claims WHEN A NEW HIRE STARTS BEFORE CREDENTIALING • Start credentialing the day the offer is signed, not on their first day • Schedule only patients from payers they are already credentialed with, and add more as each payer comes through • If you hold claims until credentialing is complete, watch every payer's timely filing limit • Incident-to has strict requirements and does not fit every service or provider THE FOUR MOST COMMON LOCUM MISTAKES 1. Billing locum visits without Q6 2. Using Q6 for a new hire waiting on credentialing 3. Going past 60 days without enrolling the covering physician 4. Assuming commercial payers follow Medicare's rules