Dear Mike,
You bring up several key points. First, never completely trust what a vendor tells you. Some may know their stuff, but others may say anything to make a sale. One recent encounter I had with a vendor was for cold-light laser. The vendor told me I could code it as a massage code since I was rubbing the laser on the patient. Not unless I want to be roommates with Bubba!

If the doctor is a participating physician with Medicare, and Medicare communicates to that secondary insurance carrier, Medicare will automatically send the information over to the secondary carrier. An example would be AARP. Medicare automatically sends the information over to AARP so the patient does not have to file the secondary. This is called Medigap.

If the doctor is a non-participating physician classification with Medicare, then the patient files the secondary insurance themselves. As physicians, we have to file the Medicare insurance for the patient, but not the secondary insurances. Some doctors will file it for the patient; others will print out a claim form and give it to the patient to mail themselves.

You can find how to submit info to Medicare on your carrier's website. You can file claims electronically or on paper via mail. When you begin filing electronically, you must be HIPAA compliant the day you first file electronically. You MUST file a claim for a Medicare patient, whether you are a Par or non-Par doctor. You cannot give a superbill to the patient for covered services.

First, apply to Medicare using the 855i form available on the Medicare website. You will not be able to file any claims until your application is processed (3-5 months), however you can still see the Medicare patients, keep their claims on hold until you are approved, then file all of them once you are approved. Don't forget that if you are incorporated, you need a type 1 and a Type 2 NPI number. If you incorporated, you must also file as an individual and as a corporation with Medicare.

You can have the patient file the superbill themselves if you want a "cash" arrangement. This is not allowed for Medicare, Medicaid and certain PPO contracts, so check your PPO contracts first

Heather,
As a corporation, you are an employee of that corporation. As such, your NPI Type One number will go on the claim form as the physician who performed the service (Line 24J). The payment is then made to the corporation, which requires a NPI Type Two number. Therefore, you will need both Type One and a Type Two numbers. In fact, the IRS reports information to CMS telling them that you are operating as a corporation. If you fail to get a Type Two number, all payments will cease to you.