Working as a locum can be an excellent opportunity to gain experience in various practices with various patients, systems, and education. Traditionally, locum tenens meant "to hold the place of." But for doctors, nurses, and physician assistants who practice this way, and for their patients, locum tenens means so much more.
The problem with patients arises while billing for them as it can sometimes feel confusing for users how to bill locum tenens physicians for their services. In this article, we provide you with the information you need to use the billing process for locum tenens physicians.
This article just gives a brief introduction to billing tips. For a more detailed explanation, you can connect with ProLocums, the trusted healthcare staffing agency, and get all your queries or doubts solved.
Billing for locum tenens providers is not as simple as billing for regular employees because the rule governing reimbursement is Medicare specific and only applies to Medicare.
Medicaid and commercial payers may have adopted Medicare's rule. Still, if not, you must confirm with the payer that their rules govern locum tenens billing, and if not, you must understand their specific rules.
CMS policy recommends that locum tenens physicians provide services to Medicare patients for 60 consecutive days during their duties. The only exception to this rule is if the regular physician is called to active military duty.
Suppose you utilize a locum physician for much less than 60 days. In that case, the locum's treatments can be invoiced using the missing physician's NPI number with the Q6 qualifier to indicate that they're a locum tenens physician.
Using the missing physician's NPI number allows the absent physician to charge Medicare as though they provided the therapy personally; however, this time cannot exceed 60 calendar days.
An individual serving as a locum tenens covers an absent physician for at least 60 consecutive days. A Locum Tenens physician must be credentialed separately if the assignment exceeds 60 days. Rather than being paid for individual services, locum tenens physicians are paid on a per diem or fee-for-service basis. Medicare beneficiaries must seek care from an absent credentialed physician who is physically unavailable to see patients.
The locum tenens doctor can be utilized for 60 days with the Q6 modifier if the regular physician returns for a brief period, even one day. You can ensure long-term coverage this way.
Generally, Locum Tenens physicians are familiar with the documentation requirements for reimbursement of services provided under the regular physician's NPI. Locum Tenens physicians must enter a Q6 modifier for their services in box 24D of the CMS-1500 claim form. You must enter the original physician's NPI in box 24J, which is the rendering provider's ID.
Locum tenens nurse practitioners and other non-physician providers are not subject to the same billing guidelines as locum tenens physicians. In the case of APP contracts covering the absence of a physician, contact your local Medicare administrative contractor for details regarding billing and the Q6 modifier.
The best way to make this process easier is to work with a trusted healthcare staffing agency like ProLocums. A right partner like ProLocums will provide you with a credentialing team that will know about your enrollment process and helps your staff with billing on time.
At ProLocums, we believe there is no one-size-fits-all way to organize partnerships with hospitals, and the same applies to our relationship with the physicians we hire to care for patients.
Whether you are employed and receiving a W-2 or are an independent contractor physician receiving a 1099 depends on various factors including specialty and role. Most physicians have been W-2 employees at some point, so they inherently understand this model. The independent contractor (IC) model is a little more foreign to many, so it is important to understand the pros and cons of this tax status.
Transitioning from an employed model to being an independent contractor physician (ICP), or starting your career as an independent contractor, presents a variety of often bewildering questions. One of the first is likely about the difference between forming an LLC and an S Corp.
Choosing the right business structure is a complicated question that depends on your state, personal financial goals, and family needs. To help physicians navigate these choices, we've teamed up with DocWealth.io, which specializes in providing CPA services for 1099 physicians to maximize their earnings. Consulting with a professional like DocWealth.io can help you come up with a plan that fits your particular situation and needs.
In this article, we will discuss why being a 1099 physician is the best option and explore whether you should form an S Corp or an LLC to maximize your financial benefits.
When deciding between forming an LLC or an S Corp as a 1099 physician, it's crucial to understand the distinctions and benefits of each structure.
S Corporation (S Corp): An S Corp, or S corporation, is a type of business entity that offers the advantage of pass-through taxation. This means that the company's profits and losses are passed directly to the individual owners, who report them on their personal income tax returns. This structure helps avoid the double taxation commonly associated with traditional C corporations. Owners of an S Corp can also save on self-employment taxes, as they can take a reasonable salary and distribute remaining profits as dividends, which are typically taxed at a lower rate. [not subject to additional self employment taxes.]
Limited Liability Company (LLC): An LLC, or limited liability company, blends the benefits of a corporation with the flexibility of a partnership or sole proprietorship. LLCs are relatively easy to establish and operate, offering significant flexibility in how they are taxed and how profits and losses are allocated among the owners. The members of an LLC are not personally liable for the company's debts and obligations, providing a layer of personal asset protection. Profits can be distributed among one or more members, making it a versatile choice for many business owners.
Contrary to popular belief, the primary purpose of forming an LLC for physicians is not necessarily to shield from liability, but to create an opportunity to save money through electing S Corp taxation.
How Does an LLC Help Lower Your Tax Bill? An LLC can choose to be taxed as an S Corp, allowing the business owner to take advantage of pass-through taxation while also potentially reducing self-employment taxes. By electing S Corp status, the physician can receive a portion of their income as a salary (subject to payroll taxes) and the remaining as a distribution (not subject to self-employment tax), leading to overall tax savings.
Many independent contractor physicians opt to form an LLC for its ease of setup and then elect S Corp taxation for federal tax benefits. This setup allows physicians to benefit from the simplicity of an LLC while enjoying the tax advantages of an S Corp.
Here’s how it works:
1. Formation and Election:
2. Revenue Flow:
3. Salary and Distributions:
As both the employer and employee, the independent contractor physician can significantly reduce self-employment taxes. For 2024, the self-employment tax rate is 15.3% on earnings up to $160,200, with an additional 2.9% on income above this threshold. By balancing W-2 wages and distributions, physicians can save thousands of dollars annually, primarily on payroll taxes, while still meeting their income tax obligations. This strategy offers substantial savings for independent contractor physicians.
Dr. Smith owns Smith Medical, LLC. ProLocums pays Smith Medical, LLC $325k through 1099 payments. Smith Medical, LLC then pays Dr. Smith a $125k salary via W-2. As a result, Dr. Smith’s payroll tax is calculated only on the $125k salary instead of the entire $325k.
Payroll Tax Implications Without an LLC:
Payroll Tax Implications With an LLC:
By structuring his income this way, Dr. Smith saves over $10,000 in payroll taxes.
The next common question is, “What about the $200k that I’m not taking as wages?” That $200k remains your money and can be accessed through owner distributions or dividends. You can transfer these funds from your business bank account to your personal account with ease. The advantage here is that this $200k is not subject to payroll tax, though it is still subject to income tax.
Forming an LLC and electing S Corp taxation has numerous benefits, but there are also potential downsides. These include compliance with additional tax rules and regulations specific to S Corps. Physicians considering this option should weigh the benefits and drawbacks and consult a tax professional before making a decision. For more information, visit DocWealth.io.
In recent years, the tax landscape for independent contractors has become increasingly complex, making much of the existing online information outdated. Consulting with a tax professional is crucial for understanding your specific situation.
Qualified Business Income (QBI), outlined in Section 199A of the tax code, refers to net income from a qualified trade or business eligible for deductions under the Tax Cuts and Jobs Act of 2017. For independent contractor physicians, this income is eligible, but only if it falls under certain thresholds:
QBI Example:
Understanding QBI and its implications can significantly impact tax planning and savings for independent contractor physicians. For more detailed advice tailored to your circumstances, visit DocWealth.io.
The 2017 tax law that introduced QBI also capped state and local tax (SALT) deductions at $10,000, targeting high-income earners like physicians. To counteract this, many states have introduced or proposed a Pass-Through Entity (PTE) Level Tax. If your state offers PTE, you can pay a portion of your state income tax through your LLC and receive a federal deduction.
For Example:
This strategy allows high earners to navigate the SALT deduction cap effectively.
Organizing an LLC and paying yourself as an employee adds complexity but can lead to substantial savings. In the examples above, Dr. Smith could save:
These figures don’t include potential savings from retirement contributions or business deductions. While these examples are simplified and may not apply to your specific situation, the potential benefits are significant.
For personalized advice, consult your CPA or schedule a free 30-minute session with DocWealth.io.
07/15/2024
Physician income has been on a steady rise, with the average compensation for U.S. physicians escalating from $352,000 in 2022 to $363,000 in 2023 according to the Medscape report. However, these figures vary significantly across specialties and demographics, particularly gender. In 2023, male physicians earned an average of $91,000 more than female physicians, a stark 29% difference.
The disparity is even more pronounced among specialists. Male specialists earned an average of $435,000 in 2023, compared to $333,000 for their female counterparts, resulting in a 31% difference. Encouragingly, the gender pay gap is much narrower in locum positions, averaging about 15%. In some specialties, there is no gap, and in others, women earn more than men.
Here is a detailed analysis of the average compensation across six specialties and how it varies by gender as per the Medscape report.
Anesthesiology is among the highest-paying specialties and continues to grow. Average compensation for anesthesiologists increased by 10% in 2022 and an additional 5% in 2023. In 2022, male anesthesiologists earned an average of $459,000, while female anesthesiologists earned $419,000. Although a pay gap exists, it is smaller compared to other specialties and is shrinking; the gap decreased from 17% in 2021 to 10% in 2022.
For locum anesthesiologists, the pay gap is minimal. Women earned an average of $298 an hour, while men earned $310 an hour, a difference of just under 4%.
Cardiology is the third-highest-paid specialty, with an average income of $525,000 in 2023. Although specific gender pay gap data for cardiologists is not available, the overall average gender pay difference for specialists is 31%, translating to more than a $100,000 difference.
Locum compensation for cardiologists is more equitable. Women earned an average of $246 an hour, compared to $247 for men.
In family medicine, male physicians earned an average of $282,000 in 2022, while female physicians earned $230,000, a 23% difference. This gap, however, is narrowing; it was 26% the previous year. Locum compensation for family medicine doctors shows no disparity, with both men and women earning an average of $117 an hour.
General surgeons earned an average of $423,000 in 2023, though gender-specific data was not provided. Interestingly, in locum positions, female general surgeons earned 11% more than their male counterparts. Women earned an average of $179 an hour, while men earned $159 an hour.
While Medscape did not report on the gender pay gap for neurologists, the average compensation rose from $313,000 in 2022 to $343,000 in 2023, a nearly 10% increase. In locum roles, male neurologists made about 5% more than female neurologists, with average hourly rates of $255 and $242, respectively.
The field of obstetrics and gynecology has one of the smallest pay gaps in medicine. In 2022, male OB/GYNs earned an average of $349,000, while female OB/GYNs earned $329,000, a 6% difference. By opting for the latest locum jobs, women earned slightly more than men, with hourly rates of $164 for women and $161 for men.
These figures are averages, and individual compensation can vary widely within each specialty. Nonetheless, there are ways for physicians, regardless of gender, to increase their earnings:
By leveraging locum opportunities, understanding their worth, and negotiating effectively, physicians can work towards closing the gender pay gap and ensuring fair compensation for their expertise and hard work. Visit the ProLocums website to find more locum opportunities.
07/12/2024
Physicians venturing into locum work, or considering it, often have numerous questions regarding the process, benefits, and what to expect while on assignment. To address these queries, ProLocums has created a comprehensive series of FAQs. Keep reading to learn more.
Working with a locum staffing agency offers several advantages. Agencies provide access to multiple opportunities, both regionally and nationally. For instance, a physician might work at a large metropolitan teaching hospital one month and a remote Indian Health Service clinic the next. If a physician prefers a particular practice style, such as rural medicine, agencies can often provide consistent work that aligns with these preferences. Additionally, agencies like ProLocums propose varied support services that save doctors energy and time significantly. Furthermore, working through an agency also helps doctors stay busy, minimizing downtime between assignments.
While some providers prefer negotiating their own locum jobs to secure higher pay rates, using an agency simplifies the process. ProLocums can help locate the ideal assignment, whenever and wherever you expect. With agency assistance, physicians are well-prepared for their next exciting opportunity. Although online job boards exist, many healthcare organizations prefer working with locum staffing agencies to fill positions quickly. Agencies not only provide physician staffing services but also manage contracts, paperwork, state licensing, and the credentialing or privileging processes required for each position, enabling physicians to start work as soon as possible.
A reputable, full-service locum staffing agency typically offers the following:
To maximize locum work opportunities, maintain regular contact with your recruiter and foster a good relationship. Being proactive in communication will secure more jobs than waiting for the agency to contact you. Be specific about your preferences and keep your CV updated with your latest experience and goals.
Yes. As an independent contractor, you have the freedom to choose where and when you practice. You can select from the opportunities presented by the agency and decide which assignments to take. Agencies should not dictate your work schedule or location.
Your first contact with a locum staffing agency is usually through a recruiter who will gauge your interest in locum practice. The recruiter will gather information about your medical training, licensure, and personal and professional interests. They may also contact you about specific opportunities and coordinate logistics like licensure, credentialing, travel, and accommodation.
Some agencies, like ProLocums, allocate a staffing consultant to each doctor and client. This consultant ensures coordination of all assignments and works with both the Licensing and Credentialing Departments to ensure that physicians have all necessary documents for each assignment.
Finding the best locum agency requires some research to ensure they meet your needs in terms of:
No, locum agencies do not deduct any amount from your salary. Instead, they charge the hospital a fee for finding you, ensuring compliance, and managing the booking process.
Ideally, begin the registration process 45 to 60 days before you want to start work. This timeframe allows enough time to complete registration and handle any issues or delays. It also provides the opportunity to book popular shifts in advance, which can fill up quickly as the start date approaches.
For more information about working on a ProLocums assignment, please contact us today or visit our Job Search page.
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