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Assigned versus Nonassigned

There is a simple difference between claims where you accept assignment with Medicare and where you do not accept assignment. It is important to remember these terms, because they establish how you will receive payment for the equipment or supplies that you provide.

If you are a participating provider, you have signed an agreement with the NSC that you will accept assignment on all claims that you bill for at least the current 12 month period (you may change to nonparticipating for the next year, if you wish). This means that for every claim you bill, you will accept Medicare's allowable as payment in full, i.e. you will accept the 80% that Medicare pays and the 20% that the patient pays. You may not bill the patient for the difference between your charge and the allowable; this becomes your liability. The patient, however, is responsible for any deductibles on the claim. Accepting assignment also means that Medicare will pay you, instead of the beneficiary. The beneficiary will still receive a Medicare Summary Notice, but payment from Medicare will come directly to you.

So, as you can see, the main benefits of being a participating provider are that Medicare makes payment directly to you and also that, after processing, Medicare will automatically send the claim on to any Medigap insurers that the patient has, eliminating the need for you to print secondary claims and reducing your wait for payment.

On the other hand, if you are not a participating provider, you do not have to always accept assignment. You may decide on each case, whether or not you would like to accept assignment. You may not split a date of service, though - in other words, you must either accept or not accept on all items for a particular date of service. If you choose to accept assignment, the usual rules apply. If you choose not to accept assignment, then a few things will happen. The patient will be responsible for payment in full to you. You do not have to accept Medicare's allowable; you may expect the full amount that you charged to Medicare. You will not receive any payment or correspondence from Medicare about the item. Medicare will issue an EOB and/or check to the patient and it will be his/her responsibility to pay you the money. Medicare will still not pay more than 80% of the allowable to the patient, but the patient may still be held liable for the full amount. If Medicare denies the claim, the patient still owes you and it is his/her job to take issue with Medicare if he/she feels that the claim was denied incorrectly. You may choose to help the patient with contacting Medicare if you would like. In the case of not accepting assignment, you may also collect the full amount from the patient in advance, but if you do so, you must indicate this on the claim that you submit to Medicare.

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