Medicare Assignment

Medicare Assignment

Medicare Assignment:  Doctors who don’t accept assignment may charge you more than the Medicare approved amount.  Although, they can not bill more than 15% over the Medicare approved amount.  This is called the “limiting charge.”  The limiting charge applies only to certain services. It  does not apply to some supplies and durable medical equipment (DME).  When you purchase certain supplies and DME, Medicare will only pay for them if the suppliers are enrolled in Medicare.  It does not matter who submits the claim  either you or your supplier.  Some states do not allow excess billing even if a doctor is not accepting assignment.  (Connecticut is a good example)

Your doctor or other health care provider may recommend you get services that Medicare doesn’t cover. . If this happens, you may have to pay some or all of the costs. (Most likely all of the costs if Medicare does not approve.) It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.  Some clients can use the blanket statement “I only want receive procedures that are approved for coverage by Medicare.  I must be told of any service that  Medicare does not cover before it is performed”   You need to make sure that the doctor is informed of this before you receive any services from him.