Clear Billing: Embracing Medicare Part B Assignment

 Bottom line: accepting assignment when providing services under Medicare Part B is a simple, important step for both you and your beneficiaries, to ensure that the payment process runs smoothly and that neither you nor they pay too much. This article explains in detail what accepting assignment means.

Meaning of Accept Assignment

 Accepting assignment means asking that the Medicare program pay directly for services provided under Medicare Part B to beneficiaries. If a provider accepts assignment, that provider will ask that the approved charge – the charge a Medicare Administrative Contractor (MAC)/carrier applies to the evaluation of that service – be deemed the actual charge of the Part B service. In accepting assignment, the provider is precluding the possibility of the beneficiary, or any other party being billed for covered Part B services in excess of the applicable Part B deductible and coinsurance.

Effective Date and Duration of Agreement

 This agreement to accept assignment will be effective on the date it is filed with any MAC or carrier during the enrollment period and will continue through the last day of the calendar year next following the effective date and will automatically renew each year thereafter for a period of 12 months from the first day (January 1) of the next following year, unless otherwise terminated pursuant to the conditions specified above.

Termination of Agreement

The agreement to accept assignment may be terminated under specific circumstances:

 1. Voluntary Termination: 

The agreement may be terminated voluntarily by a provider by notifying each of the MACs or carriers with which it has filed the agreement in a particular enrolment period during any calendar year (usually near the end of every calendar year). If notification is provided for termination of the agreement during this period, then the agreement terminates on 31 December of that year.

 2. Non-Compliance:

 the agreement may be terminated by the Centers for Medicare & Medicaid Services (CMS) upon a finding — after notice and an opportunity for a hearing — that the provider has substantially failed to comply with and fulfil the agreement, in which case the provider is notified in writing of the termination, and penalties may be imposed for violations. 

Implications for Providers and Beneficiaries

 It is quick and easy for providers – allowing them to meet their obligations to the Medicare Benefits Administrative Claims (‘BACT’) Forms – which streamlines the billing process so Medicare can pay directly for covered services and eliminates uncertainty and surprise for beneficiaries, who know how much they will owe. By accepting assignment, the provider protects beneficiaries from billing balances higher than the Medicare allowable amount.

 The assurance for beneficiaries that their provider accepts assignment (and, for beneficiaries, paying nothing more than the Medicare deductible and coinsurance amounts) can help them better plan for their health expenses without financial surprises. 

 In conclusion, it is important to be clear about what assignment in Medicare Part B means. As a patient/beneficiary, you should know your rights and be aware that your doctor/supplier is not allowed to charge you more than the scheduled fee before Medicare pays the doctor/supplier.