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Non-Assigned vs. Assigned: What You Need to Know

Posted on in Billing/Reimbursement

By Ronda Buhrmester, VGM Reimbursement

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.

What is a Non-participating Supplier?

Suppliers who choose not to sign the participation agreement are referred to as non-participating suppliers. For non-participating suppliers who bill the claim as non-assigned, the Medicare payment (which is 80 percent of the allowable) is sent directly to the beneficiary.  The non-participating supplier would collect the charges up front from the beneficiary when doing the claim as non-assigned.  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. Non-participating suppliers are not required to file a claim to secondary insurance. Non-participating suppliers are required to accept assignment when the beneficiary has both Medicare and Medicaid.

Open enrollment forms are mailed to all active suppliers every November. If an existing non-participating supplier wants to become participating, then the agreement form must be received during open enrollment and postmarked before December 31 of that year.

If a participating supplier wants to become non-participating, they can request to become non-participating by sending the request to the NSC on their company letterhead. The request must be postmarked before December 31 of that year to become non-participating effective January 1 of the next year.

Once entered into, the assignment agreement may not be rescinded by the non-participating supplier unless done so by mutual written agreement of the supplier and beneficiary. This agreement must be communicated to the DME MAC before a notice has been sent for the claim determination. Participating suppliers may not rescind the assignment agreement during the period of participation contract.

Suppliers who have been awarded a competitive bid contract are required to accept assignment.

When accepting assignment, the supplier is bound by law to accept the DME MAC’s determination of the approved amount as the full fee for the service rendered. The supplier may not bill, or accept payment for, the amount of the reduced charges. However, an attempt must be made to collect (1) 20 percent of the approved charge (coinsurance), (2) any amount applied to the deductible, (3) any non-covered charges and (4) the additional charges when an ABN upgrade is executed.

Additional Resources

For more information on competitive bidding and reimbursement alternatives, download a free copy of the 2016 HME Business Playbook, today.

 

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