Billing dental insurance for the locum tenens dentist

By James Anderson, DMD, DrBicuspid contributing writer

August 14, 2020 -- No practicing dentist likes to think that there will be a day when he or she can't make it into the office from an injury, illness, or family crisis. Most of us don't plan for anything contrary to happen, and we go on day after day without a second thought.

James Anderson, DMD
James Anderson, DMD.

If you employ an associate who can take over in the event of your absence, your worries are much less. However, if you don't, you will need to hire a locum tenens dentist(s) for the interim until you return on your feet or the crisis has passed. Non-ADA members can also purchase a downloadable PDF of "Guidelines for Mutual Aid Agreements in Dentistry" in the ADA catalog.

The definition of locum tenens, simply translated from Latin, is "to hold a place." Locum tenens dentists substitute for other dentists temporarily for hours, days, or even a year.

Needing to find a dentist who is available for a locum tenens position can catch you in a vulnerable position unless you plan for this unexpected event. A locum tenens dentist must be licensed by the applicable state and have a current U.S. Drug Enforcement Administration (DEA) license. If in network with insurance plans, you must communicate with all third-party payors immediately. If there is any change in treating dentists, the insurance companies need to know.

How to bill insurance companies as locum tenens

Locum tenens is not a contracted provider with the insurance company. The name and Type 1 National Provider Identifier (NPI) number of the doctor who performed the treatment must be reported on the claim form. Most dental payors consider it a violation for a locum tenens doctor not to declare himself or herself as the treatment provider. However, some dental payees will grant temporary in-network status to locum tenens doctors. Obtain this information before treatment, and other payors will request a narrative put in under remarks that "procedures on this date were provided by Dr. Jack Jones, Type 1 NPI number, locum tenens."

The treating doctor always has a Type 1 NPI number. On claim form 2012 ADA, the NPI number, license number, and provider status are reported in sections 53 through 58. On the 2019 ADA claim form, the reporting of the treating dentist and the billing dentist is recorded in sections 48 through 58.

If the treatment provider (locum tenens) is out of network, the benefit check may go to the patient. This must be discovered by contacting the payor before the treatment is rendered. The ADA claim form allows one field for the billing entity and a separate one for the treating dentist, enabling payments sent to the practice of the owner dentist/entity. The treating dentist (locum tenens) signs box 53 of the claim form, signifying that he or she has performed the services under his or her license.

The locum tenens doctor Type 1 NPI reports any services he or she performs or supervises (as with the dental hygienist). It is considered fraudulent to report the owner as the treating dentist when it isn't true. The same goes for a new associate who is not yet credentialed by a preferred provider organization (PPO) or Medicaid payor.

The in- or out-of-network status of the treating doctor usually determines reimbursement from insurance payors. If the owner/billing entity is in the network, but the treating locum tenens is out of network, the claim will be paid as out of network. It is essential to find out from the payors how the situation is reimbursed so that you can make the proper financial arrangement with patients treated by the locum tenens dentist. Patients do not like surprises, and they need to know what to expect, especially during a pandemic where uncertainty is on everyone's mind.

It is far better to be proactive and plan for unexpected events than to be vulnerable and at risk to the unforeseen.

James Anderson, DMD, is a practicing dentist in Syracuse, UT, and is the CEO and founder of eAssist Dental Solutions. He can be reached via email.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.


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