What Does “Accepting Assignment” Mean?
Medicare is a cost reimbursement program, like many insurance policies. This means that the beneficiary must incur a charge — usually associated with having an examination or procedure performed, or purchasing an item of equipment — before a claim can be submitted. After the charge is incurred, the claims procedure begins. In Medicare, a claims procedure has evolved that is called “accepting assignment.” Medicare has set a fee schedule for many covered procedures and devices, thus suppliers (manufacturers and their representatives) can develop a reasonable expectation of the amount they will be reimbursed. To make the service delivery and billing processes easier for their patients and customers, many manufacturers have agreed to follow a practice that is the equivalent to “billing Medicare first.” Suppliers know Medicare will pay only 80% of the fee schedule or actual cost of the device, so the supplier charges 20% of this amount as a co-payment to be paid by the beneficiary at the
When a provider/supplier accepts assignment, they agree to bill the beneficiary only for any coinsurance or deductible that may be applicable, and accept the Medicare payment as payment in full. Medicare usually pays 80% of the approved amount directly to he provider of services after the beneficiary meets the annual Part B deductible of $100. The beneficiary pays the other 20%. There are several specialties that have mandated participation which are listed below in question 6. But for those with the option, if they choose not to participate, they must still bill Medicare if they are enrolled and see beneficiaries, but may decide on a claim-by-claim basis whether to accept assignment. Assignment also pays at a higher rate than non-assigned.