What does ‘accepting assignment’ mean?
Accepting assignment is a real concern for those who have Original Medicare coverage. Physicians (or any other healthcare providers or facilities) who accept assignment agree to take Medicare’s payment for services. They cannot bill a Medicare beneficiary in excess of the Medicare allowance, which is the copayment or coinsurance. While providers who participate in the Medicare program must accept assignment on all Medicare claims, they do not have to accept every Medicare beneficiary as a patient.
There are basically three Medicare options for physicians.
- Physicians may sign a participating agreement and accept Medicare’s allowed charge as payment-in-full for all of their Medicare patients.
- They may elect to be non-participating, in which case, they make decisions about accepting Medicare assignment on a case-by-case basis. They can bill patients up to 15% more than the Medicare allowance. Some Medigap policies offer a benefit to cover this amount, known as Part B excess charges.
- Or they may opt out of Medicare entirely and become private contracting physicians. They establish contracts with their patients to bill them directly. Neither the physicians nor the patients would receive any payments from Medicare.
Accepting assignment can also be a concern for beneficiaries with coverage other than Original Medicare, including those
- in a Medicare Advantage Private Fee-for-service (PFFS) plan who get services outside the network
- in a Medicare Advantage Medical Savings Account (MSA) plan because this plan does not feature networks
- with a Medicare Cost Plan receiving services outside the network