2 news Substitute physicians and locum tenens WHAT YOU SHOULD KNOW When a doctor is out for a short time, another physician can step in to make sure patients continue receiving care. Medicaid allows this through 2 types of short-term arrangements: reciprocal and locum tenens. Knowing the difference helps keep billing clear and compliant. Per Texas Medicaid Provider Procedures Manual (TMPPM) Vol. 2, Section 9.2.3, both arrangements allow a substitute doctor to take over when the regular physician is away due to illness, vacation, training, or military service. A reciprocal arrangement is when another Provider covers for up to 14 days. This does not require a written agreement, and you will use modifier Q5 when billing. A locum tenens arrangement is used for longer absences: up to 90 days, or more if the doctor is on military duty. This type of arrangement must be in writing, and you will need to use modifier Q6. A few reminders ■The substitute doctor must be enrolled in Texas Medicaid and not on the HHSC exclusion list. ■Bill under the regular doctor’s NPI, and include Q5 or Q6 in Block 24D of the CMS 1500 form. ■Enter the substitute’s name and address in Block 19, not Block 33. ■For group practices, list the NPI of the doctor being substituted in Block 24J. Following these steps helps keep billing accurate and protects Medicaid integrity. For more details, see TMPPM Vol. 2, Section 9.2.3 or reach out to Provider Relations or Compliance. We are happy to help. El Paso Children’s Hospital: Here we grow again! El Paso Children’s Hospital (EPCH) opened its second urgent care center at 13647 Eastlake Blvd., Suite 204. It is open 365 days a year, from 9 a.m. to 9 p.m. Natalia BetancourtGuzman, MD, pediatric cardiologist, completed her fellowship in pediatric cardiology at the University of Minnesota. She joined the EPCH cardiology team in August and is scheduling new patients. Kristopher Hooten, MD, pediatric neurosurgeon, is joining the EPCH neuroscience team this September. He is fellowshiptrained in adult and pediatric neurosurgery and has specialized expertise in traumatic injuries to the brain and spinal cord. He was the first American Board of Pediatric Neurological Surgery-certified pediatric neurosurgeon in the U.S. military. German Lozano, MD, pediatric nephrologist, joined EPCH in May. He returned to El Paso after working at St. Christopher’s Hospital for Children in Philadelphia and Phoenix Children’s Hospital. Ethel Aguirre, MD, pediatric geneticist, recently completed her clinical genomics residency at the Mayo Clinic in Rochester, Minnesota. She is a graduate of the pediatric residency program at Texas Tech University Health Sciences Center, El Paso, and is excited to return to help serve children in our community. Marcella Woiczik, MD, and John Heflin, MD, pediatric orthopedic surgeons, will join EPCH in the fall. Dr. Woiczik is an expert at treating club feet and osteogenesis imperfecta and has a special interest in hip pathology and dysplasia. Dr. Heflin specializes in pediatric spine deformity, fracture care, and general pediatric orthopedics.
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