Q. As a Non Par provider with Medicare, what do we do with secondary insurance? Must non-Par doctors submit claims to Medicare on behalf of the patient? Does Medicare automatically roll-over payment reports to the secondary? Do we still need a denial of both covered and non-covered services to submit to the Secondary? How should it work?

A. Most of your answers are found on pages A-97 to A-112 in your 2009 ChiroCode DeskBook. Read them for a better understanding of Medicare, including the unique difference between Medicare "Supplemental" and "Secondary" policies. You did not ask about them, but you need to know the difference.

As a general rule, all Active Treatment (AT) CMT services are "covered services" and must be submitted. Non-covered services (other than CMT codes) do not have to be submitted to Medicare. If you have a CMT service (98940-98942) that is not covered (e.g. Maintenance), you need to have the patient to complete an ABN form, which determines if you submit or not.

Medicare contractors are only required to automatically forward payment reports to secondary or supplemental insurance if you are Participating. For non-covered services, you might want to save a lot of time and hassle by submitting directly to the Secondary payer. There is a great letter on page A-108 for direct submission to the Secondary.