ND visit - Medicare w/secondary

Our ND has had to see a couple medicare patients for acute visits (CPT® 99214) while the MD was on vacation. Both have medicare as primary, with commercial insurance secondary. The ND normally doesn't see medicare pts because is not contracted, but the secondaries do cover ND services. We are in a quandary over how to bill. If bill medicare, will it automatically be non-covered services so patient responsibility and forwarded to secondaries who will pay, or will it be denied as unprocessable, in which case non of the charges are allowed and patient is not responsible?

re: ND visit - Medicare w/secondary

If not contracted, cannot bill Medicare

re: ND visit - Medicare w/secondary

So if can't bill medicare, do we bypass primary and bill directly to the secondary? Or because medicare doesn't cover, the secondary won't cover either? If this is the case, having them sign the ABN and pay time of service is the best (and only) option.

re: ND visit - Medicare w/secondary

I can't speak to the secondary and who they cover or not. An ABN is one answer but depends on payer and if they consider this a bundled service. If Medicare is primary but do not recognize the provider it will probably be returned.