Well, here is a scenario that you need to know what you should
do.
If your physician is not enrolled with Medicare either a non-par or
par provider, he can still of course see and render medical
services to a Medicare patient or beneficiary but can NOT
submit claims nor bill the patient.
What about if there is a secondary insurance to Medicare? -
Even if there is a secondary insurance, they will not process the
claim unless Medicare processes the claim first.
Your physician must really be enrolled with Medicare to be able
to send claims for his/her services on Medicare beneficiaries.
Even an ABN will not help (it is not even related to the issue with
the provider not being enrolled with Medicare!).
If your physician intends to enroll with Medicare or intends to
reactivate his/her enrollment with Medicare, you need to submit
two Mandatory forms:
CMS 855i
CMS 588
Then, while the application is being processed. You can render
services to the Medicare patient and submit your claims when
your provider becomes enrolled with Medicare.
Click here for more information on the claim filing time limitation
for Medicare Claims?
**** For more references: Consult your CPT code books. The National Correct
Coding Initiative (NCCI) and third pary payer payment policies and guidelines
*** another helpful article from Ms. Pinky
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