HME Playbook Snapshot: What HME Providers Need to Know about Refusing Assignment

Posted on in Billing/Reimbursement, Growth Strategies

More than 600 HME providers have downloaded the 2016 HME Business Playbook. What are you waiting for? Navigating Medicare changes can be complicated, especially when it comes to deciding whether to take assignment or not. Ronda Buhrmester, VGM reimbursement specialist, and Mark Higley, vice president, Regulatory Affairs, shed some light on the topic in the section titled “Competitive Bidding in 2016 and Beyond.”

An assignment agreement is between a supplier and a Medicare beneficiary. The option of accepting assignment belongs solely to the supplier. Suppliers have a choice to become a participating or non-participating Medicare supplier. Suppliers can change their participation status annually. Participation status is part of the enrollment process through the National Supplier Clearinghouse (NSC).

Participation means the supplier always agrees to accept assignment for all services furnished to Medicare beneficiaries during a 12-month period, beginning January 1 of each year.

By agreeing, the supplier always accepts the Medicare allowed amount as payment in full and doesn’t collect more than the deductible and coinsurance from the beneficiary. By accepting assignment, the payment is sent to the supplier.

Non-Participating Suppliers

Suppliers who choose not to sign the participation contract are referred to as non-participating suppliers. For non-participating suppliers, the Medicare payment is sent to the beneficiary. The non-participating supplier can then bill the beneficiary for the difference between the submitted amount and the Medicare allowed amount, as well as the deductible and coinsurance on non-assigned claims. The non-participating supplier can choose on a claim-by-claim basis whether or not to accept assignment, except where CMS regulations require mandatory assignment.

Don’t stop here. Read on to learn more about refusing assignment by downloading your free copy of our 2016 HME Business Playbook!