What Is Medicare Assignment And How Does It Work?





To answer the question ‘What Is Medicare Assignment and How Does It Work’, it is important to understand exactly what medicare assignment means. Medicare Assignment is an agreement between health care providers, medical suppliers and Medicare stating willingness to accept Medicare payment as payment-in-full at the time of service.. While most entities accept Medicare patients, not all accept ‘Medicare Assignment’.

How Original Medicare and Medicare Assignment Differ

Under the Original Medicare Part A and B, service is rendered by Medicare participating entities on a payment-at-time-of-service basis. Under Medicare Assignment, there is no up-front payment required. All billing is sent directly to Medicare by the service provider with payment receipt coming directly from Medicare. Since there is no financial transaction between patients and healthcare providers, there is no need for any type of medical-gap insurance and no co-pay or deductible payment required on the part of the patient.

How Payment To Healthcare Providers Differs Under Medicare Assignment

If the cost of the service rendered is $120 and the provider has agreed to accept Medicare Assignment, the amount received would be $100. For providers who accept Medicare patients but who do not elect to participate in Medicare Assignment, they can legally require the patient to pay the $20 difference. If patients elect to use a provider who does not participate in Medical Assignment, they are required to pay 20% of the cost of each service until they reach the co-pay cap which for 2010 is $155 in a calendar year.

It is very important for patients to be sure that a service provider is a participant in the Medicare Assignment. Healthcare providers who do not participate can apply for a case to be accepted under the Medicare Assignment guidelines but there is no protection for the patient should the claim be denied.



Leave a Reply