Answers to Common Fee-for-Time Compensation Arrangements Questions

Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician?

Answer: Currently, a fee-for-time compensation arrangement physician does not have to enroll in the Medicare Program to see patients. They must, however, have an NPI and possess an unrestricted license in the state in which they practice.
What type of documentation should be included in the medical record for services performed by fee-for-time compensation arrangement physicians?

Answer: The regular physician or group must keep a record of each service furnished by the fee-for-time compensation arrangement physician, along with their NPI. The reason the regular physician cannot provide services should also be included in a record. In the event that Medicare requests it, there should be documentation to substantiate a fee-for-time compensation arrangement has occurred. This may be a contract, etc. All other general principles of documentation apply; the record must verify that the services performed were medically necessary and otherwise covered by Medicare in order for the regular physician to receive Medicare reimbursement.
Where can I find the guidelines for fee-for-time compensation arrangement?

Answer: CMS guidelines are found in the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 30.2.11.
When submitting the Medicare claim, which physician's NPI should be reported as the rendering provider on the claim?

Answer: Report the regular physician's NPI in item 24J on the CMS 1500 claim form or the electronic equivalent.
Can a physician who works only one shift per month be considered a fee-for-time compensation arrangement physician?

Answer: No, in such a case, the physician is a regularly scheduled physician and the fee-for-time compensation arrangement concept is not applicable.
If the regular physician terminates and leaves our group and we employ a fee-for-time compensation arrangement physician, what are the guidelines for this situation? Can we use the same fee-for-time compensation arrangement physician after the 60-day limit or can we contract with a different fee-for-time compensation arrangement physician after the initial 60-day limit?

Answer: If a physician terminates and leaves your group, a contracted fee-for-time compensation arrangement physician can see the exited physician's patients for up to a 60-day continuous period, beginning with the first day the fee-for-time compensation arrangement physician sees one of the exited physician's patients. You can initiate a contract with a different fee-for-time compensation arrangement physician after the first 60-day fee-for-time compensation arrangement substitute period has expired.

CMS requires that providers report certain reportable events within certain timeframes. The group has up to 90 days to notify provider enrollment that the physician left the group. This will affect the number of days that the second fee-for-time compensation arrangement physician will be able to provide services as a substitute.
Our regular physician will be absent for longer than 60 continuous calendar days. Can we contract with more than one fee-for-time compensation arrangement physician to see the regular physician's patients during their absence?

Answer: Yes, however, each fee-for-time compensation arrangement physician can only fill in for up to 60 continuous calendar days.
Can a rural health clinic contract with a fee-for-time compensation arrangement physician?

Answer: While a rural health clinic may contract with a fee-for-time compensation arrangement physician, the regular physician would not submit a claim to Medicare Part B for the fee-for-time compensation arrangement physician services.
Our regular physician will need to be absent for an extended period of time. Can we arrange for the same fee-for-time compensation arrangement physician to see the regular physician's patients during the extended absence?

Answer: No. The period for which a single fee-for-time compensation arrangement physician may substitute cannot be more than 60 continuous days. The 60-day period begins the first day the fee-for-time compensation arrangement physician provides services for Medicare patients of the regular physician. An exception to this 60-day rule is for regular physicians who are called to active duty in the armed forces. The time is unlimited.
Our practice is in the process of enrolling Dr. A. While awaiting the credentialing process, can we use Dr. A as a fee-for-time compensation arrangement physician for a physician who is on vacation?

Answer: No, in such a case, the fee-for-time compensation arrangement concept is not applicable. Fee-for-time compensation arrangement is only appropriate for absent physicians who retain a substitute physician to assume their professional practice for no longer than 60 continuous calendar days.
If as a medical group we are trying to replace multiple physicians at the same time, how long can we bill for a fee-for-time compensation arrangement physician?

Answer: A fee-for-time compensation arrangement situation could exist for each physician you are replacing, for a period not to exceed 60 continuous calendar days for each fee-for-time compensation arrangement physician substitute. The medical group would bill under the absent physician, based on fee-for-time compensation arrangement criteria. The medical group has up to 90 days to notify provider enrollment the date that each respective physician has left the group.
If we are not losing any physicians but just want to expand and add new physicians to our group, can we bill fee-for-time compensation arrangement physicians to add new physicians to our group?

Answer: No. A fee-for-time compensation arrangement physician is meant only for the temporary absence of a regular physician or when a regular physician has left a group practice.
Our practice employs multiple physicians of the same specialty. If one staff physician sees another staff physician's patients while their colleague is absent for an extended period (not to exceed 60 calendar days), is this considered fee-for-time compensation arrangement?

Answer: No, fee-for-time compensation arrangement is the temporary replacement of an enrolled Medicare physician with a nonenrolled physician. Your practice would bill under the NPI of the enrolled physician who sees the patient in the absence of their colleague.
Does fee-for-time compensation arrangement provisions apply to specialties such as radiology and pathology?

Answer: Yes.
Does fee-for-time compensation arrangement apply to a deceased provider?

Answer: No, Medicare only permits payment for services furnished prior to a physician’s death. When a physician becomes deceased, their billing number, NPI and enrollment are deactivated and cannot be used after the date the physician passes away, therefore, a fee-for-time compensation arrangement would not be permitted for a deceased provider.
In the case of a temporary NPP absence, can he/she use a fee-for-time compensation arrangement physician? If not, how would we handle an NPP replacement?

Answer: No. Fee-for-time compensation arrangement provisions apply only to physicians. The CMS IOM Publication 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5, Section 70 defines physician for the purposes of fee-for-time compensation arrangement billing. This includes a doctor of medicine, doctor of osteopathy (including osteopathic practitioner), doctor of dental surgery or dental medicine, doctor of podiatric medicine, or doctor of optometry, with respect to certain specific treatment, and a doctor of chiropractic.

Unless they have already done so, the NPP replacement provider will need to enroll in Medicare and submit a claim for their services.
When a physician in solo practice dies unexpectedly in an accident, can fee-for-time compensation arrangement billing be done?

Answer: No. See Answer 15.
Can a fee-for-time compensation arrangement physician see new patients?

Answer: Yes, as long as the patient requested or was seeking services from the regular physician.
Can we use a fee-for-time compensation arrangement physician for less than 60 days to replace a physician who has left our practice?

Answer: Yes.
Is the 60-day period cumulative or consecutive?

Answer: The 60-day continuous day period begins the first day the fee-for-time compensation arrangement physician provides services for Medicare patients of the regular physician. This period continues for up to 60 calendar days, with no breaks, even if the fee-for-time compensation arrangement does not see patients on some of those days. In situations where the regular physician is going to be absent for more than 60 days, an alternative plan for physician coverage and patient care should be created. An exception to the 60-day continuous rule is for regular physicians who are called to active duty in the armed forces. This time is unlimited.
What documentation would Medicare want when there is an exception to the rules as referenced above?

Answer: The CMS contractor would need to see documentation that the physician was called to active military duty.
Our physician will be out for 60 continuous calendar days, beginning June 1st. Will Medicare allow two different fee-for-time compensation arrangement physicians to substitute for the same regular physician?

Answer: Yes. A regular physician may use more than one fee-for-time compensation arrangement to substitute for their absence during the same 60-day period; however, the substitutes cannot act as such on the same day. Assuming that each fee-for-time compensation arrangement physician is providing services within their respective 60-day continuous period, fee-for-time compensation arrangement physician Dr. A can provide services, for example, on Monday, Wednesday, and Fridays, and fee-for-time compensation arrangement Dr. B can provide services on Tuesday, and Thursday, but Dr. A and Dr. B cannot be scheduled as the substitute for the regular physician on the same day.
How often can the same fee-for-time compensation arrangement physician be in the same practice? For example, a fee-for-time compensation arrangement physician covers for regular physician A during a leave of absence and then physician B takes an extended vacation.

Answer: The fee-for-time compensation arrangement physician may stay at the same practice as long as he/she substitutes for no more than 60 continuous calendar days for each respective regular physician's absence.
Can a practice bill under fee-for-time compensation arrangement physician rules when one of their hospitalists is out for an extended period of time?

Answer: Yes.
Our physician will be out on a medical leave for 90 days. Can we use one fee-for-time compensation arrangement physician the first 60 days, and then use a second one for the remaining days?

Answer: Yes.
Does the fee-for-time compensation arrangement physician have to be of the same specialty as the physician who is absent?

Answer: No.
Our practice has a high volume and our physicians are unable to see all of the patients. Can we use a fee-for-time compensation arrangement physician and bill under the provider who is out for the day if it is their regular day off?

Answer: No, in such a case, the physician is a regularly scheduled physician and the fee-for-time compensation arrangement concept is not applicable.
For a physician, who has left the practice, is there a requirement that the fee-for-time compensation arrangement physician has to start within a certain time period from the departure date of the regular physician?

Answer: No, but the eligibility period for the fee-for-time compensation arrangement physician substitution may be affected because the practice is required to notify Provider Enrollment of the change in practice status (physician left practice) within 90 days.
We had two providers leave our specialty group. We are using two fee-for-time compensation arrangement physicians to cover as we recruit replacements. Can we assign a fee-for-time compensation arrangement physicians to an absent provider and always bill their services under this provider, or do we have to bill the provider that was 'requested'? In some cases, they are new patients.

Answer: A fee-for-time compensation arrangement physician is the substitute for a physician who is absent. Once entered into, the fee-for-time compensation arrangement physician should not substitute for a different absent physician. It is the expectation that the fee-for-time compensation arrangement will see only those patients that requested the regular physician for which the fee-for-time compensation arrangement physician is substituting. This would include a new patient.
One of our surgeons retired in February. We hired a replacement and he died unexpectedly in June, leaving us with only one surgeon. The remaining surgeon is temporarily leaving for a 30-day absence in the near future. Can we bill one fee-for-time compensation arrangement physician under our retired physician for 60 days, while we search to replace our deceased surgeon, and a second fee-for-time compensation arrangement physician to cover for the remaining surgeon who will be on the day 30 absence?

Answer: It is not appropriate to contract with a fee-for-time compensation arrangement physician for the surgeon who retired in February and was later replaced by a physician who died expectantly in June. Fee-for-time compensation arrangement does not apply for a deceased provider.
On occasion, we have overbooked patients. Our office brings in another physician to assist. Is this fee-for-time compensation arrangement?

Answer: No. The physician you are bringing in is not substituting for a regular physician. To submit charges for their services to Medicare, they will need to enroll with Medicare.
If a practice wants to "try out" a doctor they are considering hiring, can the practice bill under fee-for-time compensation arrangement?

Answer: No, this does not meet the CMS definition for fee-for-time compensation arrangement.
A physician resigns from a practice. Until his new practice begins, can the same physician act as a fee-for-time compensation arrangement at the first practice?

Answer: No, in this case, the physician cannot substitute for himself. A fee-for-time compensation arrangement physician is one who substitutes for a regular physician during an extended absence.
How do other payers reimburse for fee-for-time compensation arrangement situations; are their rules more flexible?

Answer: CMS created these guidelines for physicians who are performing services reimbursed under the Medicare payment system. In order to determine how private payers reimburse fee-for-time compensation arrangement services, providers must contact the other payers.
If a practice just "needs help" to get through a busy period, i.e. a doctor is ill and working part time, can the practice hire a fee-for-time compensation arrangement physician to bill under the part time doctor's name/number?

Answer: No, fee-for-time compensation arrangement is only applicable when the fee-for-time compensation arrangement physician is substituting for the regular physician for those periods defined in the CMS IOM. It does not apply when the regular physician is working part time due to an illness.
Does the group need a signed agreement or contract for fee-for-time compensation arrangement situations?

Answer: For fee-for-time compensation arrangement physician situations, the regular physician or their group pays the fee-for-time compensation arrangement for their services on a per diem or similar fee-for-time basis. Typically, there would be a signed agreement or contract to make this situation occur.
Can the 60-day time period be renewed or extended if the regular physician remains absent for an extended period of time?

Answer: No. At the conclusion of the 60-day time period, a fee-for-time compensation arrangement situation cannot be renewed or extended with the same fee-for-time compensation arrangement physician. A new contract with the same fee-for-time compensation arrangement could be entered into if the regular physician returns and sees patients for at least one day or the practice can engage a different fee-for-time compensation arrangement physician.
Is notification to provider enrollment required when billing under fee-for-time compensation arrangement arrangements?

Answer: There is no notification required to provider enrollment when billing under fee-for-time compensation arrangement arrangements.
How does claim preparation and submission for fee-for-time compensation arrangement work?

Answer: If the conditions are met, the regular physician submits the professional services under their NPI, using the appropriate procedure codes and HCPCS modifier Q6. The regular physician receives any Medicare payment for the service.

Revised 9/21/2023