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Practical Tips Medicare Assignment and Participation: Excerpts From Practical Tips for the Oncology Practice
| Content Provider | CiteSeerX |
|---|---|
| Author | Tomkins, Julia |
| Abstract | challenges to oncologists this year, with a series of temporary patches to the sustainable growth rate (SGR) formula resulting in uncertainly about payment rates and delays in Medicare claims processing. In response to this situation, many physi-cians, including oncologists, have begun to ask questions about the Medicare program and specifically about participation and assignment of claims. This article, excerpted from ASCO’s Practical Tips for the Oncology Practice, reviews definitions and requirements of the Medicare program for assignment, partic-ipation, and private contracts.1pp4-5,71-73 Assignment of Claims Physicians can elect to takeMedicare claims on assignment. If a physician takes a claim on assignment, it means that the physi-cian receives 80 % of the Medicare-allowed payment amount directly from theMedicare program and bills the beneficiary for the remaining 20 % copayment. A physician who takes assign-ment agrees to accept these two payments as full compensation and agrees not to bill the beneficiary for any amount above the 20 % coinsurance (plus any part of the annual deductible). If a physician does not take a claim on assignment, the phy-sician does not collect anything directly from the Medicare program but instead looks to the patient for payment. The physician may generally charge the patient up to 115 % of the Medicare-allowed payment amount. Medicare reimburses the patient and does not make any payment to the physician. Even if a physician does not take a claim on assignment, the physician is legally required to submit the claim form to Medi-care on behalf of the patient. Physicians must take assignment for claims related to labo-ratory services and for drugs and biologics. If a physician has an office laboratory, the physician must accept the Medicare pay-ment amount as payment in full for laboratory services. There is no coinsurance requirement in the case of laboratory services; therefore, the payment from Medicare to the physician is the only payment received by the physician. In the case of drugs and biologics, the physician must take assignment and can charge only the 20 % coinsurance to the patient. |
| File Format | |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
