Medicare Assignment

[Danni R.]

Just got an email (PM) from a member, asking: If a healthcare provider (i.e. doctor)  does not accept assignment under Medicare, what is the most s/he can charge beyond their approved rate?


Well, I don't know why they asked me, because I am really not an expert in this field. I took a moment to look it up (Google) and stumbled across a great website that I enjoyed reading, because many things were explained in plain, easy to read lingo and format. I'd like to recommend the following site to anybody, for further reading, and research.

Center for Medicare Advocacy, Inc.
http://www.medicareadvocacy.org/FAQ_PartB.htm


ASSIGNMENT
Quote: "When a physician accepts "assignment," he or she agrees to accept the Medicare approved amount as full payment. Medicare will pay 80% and the patient will pay the 20% co-payment. When a physician does not accept assignment the patient is liable for the co-payment plus a balance above the Medicare fee schedule amount. However, under federal law there is a set limit as to the amount a physician may balance bill." 


PHYSICIANS' FEES: MEDICARE LIMITS ON CHARGES
Quote: "When an item or service is determined to be coverable under Medicare Part B, it is reimbursed at 80% of a payment rate approved by Medicare, known as the "approved charge." The patient is responsible for the remaining 20%. Unfortunately, the "approved (or "reasonable") charge," is often substantially less than the actual charge. The result of this reimbursement system is that Medicare payment, even for items and services covered by Part B, is often inadequate. The patient is left with out-of-pocket expenses. When a physician accepts "assignment," he or she agrees to accept the Medicare approved charge as full payment for the services provided. Medicare pays 80% of the approved charge. Either the patient or supplemental insurance pays the remaining 20% co-payment. No further payment is due to the physician."

(for more on this particular paragraph, visit the above referenced site, and scroll down at least 3/4 of the page).

[Steve Verno]

Something inside tells me this is a test question. 

If a provider doesnt accept assignment, the check will go to the patient.  The provider is allowed to bill the patient for 115% of the Medicare allowable. 

[Danni R.]

Something inside tells me this is a test question. 

If a provider doesnt accept assignment, the check will go to the patient.  The provider is allowed to bill the patient for 115% of the Medicare allowable. 

You might be right... it could have been a test question... sometimes I fall for it. Oh well, my contribution to make their work a bit easier (yuck). 

[Steve Verno]

To add, the same is with Tricare when the provider doesnt accept assignment.  The provider is allowed to bill the sponsor, 115% of the Tricare allowable. 

[Danni R.]

To add, the same is with Tricare when the provider doesnt accept assignment.  The provider is allowed to bill the sponsor, 115% of the Tricare allowable. 

Some years ago, a couple of these checks arrived at our house. My husband thought it was a "blessing" refund, went ahead and cashed them (without telling me), and in the end I was stuck having to pay the doctor bill out of the household money. Boy was I mad! Today, I can laugh about it. Our version of trickle down economics.

[Pay_My_Claims]

ha.......that is why i have to stay on top of payments since we are non-par

[Peter007]

Problem arises when insurance pays patient and you come to know that you dont have an accurate phone number and complete address for the patient.

[Danni R.]

Problem arises when insurance pays patient and you come to know that you dont have an accurate phone number and complete address for the patient.

Oh, yes!!!! I haven't even thought about this! Then you wouldn't have any way to call (the wife!) to collect unless you find them.

Most people leave a forwarding address with the post office, but some, especially if there are collectors after them, will try to skip town without a new address. That's when you have to know methods of how to track a person's whereabouts. When an individual or a business moves, it can be a challenge (esp. in the USA) to find the new mailing address. It's different in Germany, where residents underlie the so-called "Meldepflicht", a law that whenever people move to a new location, they have to go to the city magistrate office to register their new residency, and update their demographics (without being reminded!).

In the USA, I know that if I send a letter to an unknown address by mail, I just send it to the old mailing address and write "Address Correction Requested." This will alert the post office to send me notification of the new address in addition to forwarding the letter. If the mail is returned, the forwarding address is included on a sticker.

Collection agencies try to locate a family member, and call them.

[Steve Verno]

Bad addresses and phone numbers can be prevented through 3 words:

Verify, Verify and Verify!

Before their appointment, send a small postcard to the address given and call the phone number provided.  Have the patient sign an affidavit, get copies of their license and ask for a recent phone bill. 

If they say no, you can say no to their appointment if there is no emergency.  At this time there is no patient-provider relationship, so no abandonment.

Also, collect what is collectable at the time of service.

[Peter007]

Most of the providers are very very senstive in patient billing. They avoid contacting patient for address or other demographics information as they dont want to bother him .In most of the cases patient at the time of visit is a very innocent person and doctors by nature are kind at heart so neglect those minor issues. But when it comes to payment then their office managers have to search patient's address through search engines and insurance websites.

Most of the times patient's give their cell phone #'s and it is not possible to track them through it. I suggest to at least take a valid landline number and bank account information (Both Verified) as Steve just said.

[Pay_My_Claims]

You have no rights to my bank account or any personal information such as that. Even my SS# is something you can be hesitant about giving to a physicians office. I used to pay my furniture payment via a cc kept on file, and they had to do away with that because of fraud. Anyone can come in and have access to that information. I REFUSE to give out such ridiculous information for a MD appointment and hope a par provider refuses to see me because I won't give out a land line phone or show them a copy of my light bill. It ISN'T any of their business, nor do they need it to see me. If the provider would like to collect 100% of my deductible and coins up front for my visit that is acceptable. Sending a client a bill WILL NOT GUARANTEE you payment. As I stated before my DL doesn't have my current address on it so that means nothing.

[Danni R.]

Every new patient that arrives at the medical office for their first appointment is asked to fill out a stack of patient registration forms, releases, and questionnaires (including HIPAA) and must accept personal financial responsibility, should the health insurance company not pay.

So, you sit there with your clipboard and pen and fill out all the forms for about 10 - 15 minutes:
Name, address, date of birth, gender, phone number, previous medical conditions, allergies, health insurance information (Tricare used the sponsor's social security number), and such. A person can easily give a false address, or phone number, although that might not be in their best interest. It doesn't matter if a patient provides a landline phone number, or cell phone, as (in America) these numbers are not considered permanent, and can easily changed simply by switching phones (service provider), or phone companies.

As for myself: I never was asked for a phone bill, bank information, or credit card. The only identification card I have to show each time to register is my health insurance card, which usually is photocopied, and added into my medical chart.

Examples of typical patient registration forms in USA:

http://www.drsforms-systems.com/clinicalforms/registrationforms/windows-registration/registrationformsenglishmenu.htm

[Steve Verno]

The other day, i went to an appointment, while sitting there, a woman walked in.  They asked her for her DL. She said the same as you, Charlene.  They just stood back while this woman yelled, screamed, and berated the staff.  When she was done, they politely told her there were no appointments available and they werent accepting any new patients.  She started her tirade again.  They said she was free to go across the parking lot to the urgent care center.  They said the UCC would also ask her for her DL.  When she began to yell, scream and start all over again, a local police officer walked in. A patient in one of the exam rooms heard her and called the police.  She was asked to leave the office.  She slapped the officer and said she wasnt leaving until she was seen. Needless to say, she was hndcuffed and escorted to the back seat of the police cruiser. 

The office staff apologized. I smiled and said I understood.  But they kept their cool.  They were firm on their policy.  They started this because of the many denied claims and mail returns.  They do collect copays, coinsurance and deductibles.   

You can be firm on your personal policy but they can say, thanks and dont let the door hit you in the fanny on the way out.  It works both ways. ike I said, here, if you want a DL, you have to bring in the folowing:

One of the Following
Original or certified United States birth certificate
Valid United States passport
Certificate of Naturalization

In addition one of the following secondary documents is required:
Social Security Card
Parent Consent form of Minor
Marriage Certificate

[Danni R.]

And your grave stone!


Good story. And true.

[medauthor]

if you want a DL, you have to bring in the folowing:

One of the Following
Original or certified United States birth certificate
Valid United States passport
Certificate of Naturalization

In addition one of the following secondary documents is required:
Social Security Card
Parent Consent form of Minor
Marriage Certificate

In NJ, in addition to what Steve has listed above, when you renew your license, you must also present an original bill showing your current address; i.e. a phone bill, utility bill, etc.  When my 17 year old got her license this year, she did not have to bring in a bill, but she HAD to have a piece of mail addressed to HER with our current address.