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Understanding locum tenens in dental billing

Learn best practices to ensure smooth dental billing operations and maintain patient care during a regular dentist's absence

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What is “Locum Tenens”?

In dental practice management, locum tenens is a crucial topic. The term locum tenens, derived from Latin, means "to hold the place of" and refers to temporary dentists who fill in when the regular dentist is unavailable. This practice can potentially be utilized for unexpected absences, during changes in practice ownership, maternity leave, and in the unfortunate event that a provider passes away unexpectedly. 

The Role and Responsibilities of Locum Tenens

A locum tenens dentist can perform a variety of roles, including:

  • Providing clinical dental treatment
  • Supervising hygiene services
  • Ensuring that patients receive uninterrupted care during the absence of the regular dentist

Billing and Documentation Requirements

When a locum tenens dentist is utilized, they  must be appropriately documented on all claim forms and within any patient’s chart whom they provide an exam for, including if they are the provider present for hygiene visits that do not require an exam, and any patients they provide treatment to. 

One of the critical aspects of employing a locum tenens is ensuring proper billing and documentation. Missteps in this area can lead to inappropriate billing practices that can potentially have contract violations and/or legal ramifications. Here are the essential guidelines:

Accurate Representation on Claims:

The locum tenens dentist must be listed as the treating provider on all insurance claims, including their state license number and National Provider Identifier (NPI) Type 1 number. Claims must accurately reflect who provided or supervised the services to avoid any form of misrepresentation.

Documenting Services:

It is essential to record in the patient’s chart who provided or supervised the services. This transparency helps maintain accurate records and supports the integrity of the billing process. Listing the regular dentist on claims when they did not provide the service is a misrepresentation and can lead to disciplinary, and potentially even legal  actions. Even if a locum tenens is hired, they must be correctly identified as the service provider.

The use of locum tenens is not universally applicable in all situations. Various payers have specific guidelines on when locum tenens can be used, which may include:

Situations Permitting Locum Tenens

Unexpected Absences:

Situations such death, medical emergencies, or accidents where the regular dentist is unable to work. 

The best way to be prepared for this is to know payer and licensure polices applicable to your practice in advance, so that the appropriate steps can be taken right away if you find yourself in this situation.

Extended Leave:

Circumstances like maternity leave where the regular dentist will be absent for a significant period.

Routine absences like vacations often do not qualify for locum tenens provisions under most insurance payers - payers should be contacted individually pertaining to their policies.

Practice Transitions:

During the transition period following the sale of a practice. 

Please note that a letter from a financial institution or legal representative solely involved in the sale or purchase of a practice stating the new practice owner can bill under the previous practice owner may not be considered appropriate by state boards or insurance providers contract rules. You must confirm with each of these entities to be certain of the policies specific to you, and what they require for documentation while a new provider is being credentialed or registered. 

Best Practices for Utilizing Locum Tenens

Contacting Payers:

Before employing a locum tenens, contact each insurance payer to understand their specific provisions and requirements for locum tenens usage.

Confirm whether the payer allows for locum tenens under the given circumstances and obtain clear instructions on how to document and bill their services.

Updating Documentation:

Ensure that the dental claim forms include accurate information about the locum tenens, particularly by using the newly added space on the 2024 ADA dental claim form for indicating locum tenens.

Educating Staff:

Train your administrative staff to handle the complexities of locum tenens billing and documentation correctly. Empower your team with the skills and knowledge to have conversations with patients about how their care is managed during a locum tenens period.

Preparing for Out-of-Network Billing:

Be prepared for scenarios where the locum tenens may not be in-network with certain insurance plans, which can affect patient billing and reimbursement processes. Ensure your administrative team knows by payer how to submit claims for out of network providers and ensure that providers demographics are on file with those payers. 

Conclusion

Employing locum tenens can be a valuable strategy for maintaining continuity of care in dental practices during the absence of the regular dentist. However, it requires careful attention to billing practices and adherence to regulations to avoid inappropriate billing and documentation. . By understanding and implementing best practices, dental practices can successfully navigate the complexities of locum tenens and ensure compliance, thereby protecting their operations and maintaining patient trust.

For further guidance and assistance on managing locum tenens in your dental practice, consider reaching out to dental consultants or coding experts who specialize in this area such as Dilaine Gloege of Tidewater Dental Consulting.

Important: This blog post is for informational and educational purposes only. This post should not be taken as legal advice or used as a substitute as such. You should always speak to your own lawyer before implementing this information on your own.

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