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What does “accepting assignment” mean for a medical claim?
There is a box on the medical claim form (box 27, found near the bottom) for “Accept Assignment” – yes or no. So what does this mean?
According to Medicare,
“when a professional accepts Medicare Assignment they agree:
- To be paid directly by Medicare.
- To accept the payment amount Medicare approves.
- Not to bill you for more than the Medicare deductible and coinsurance.”
The Medicare contract states:
“Meaning of Assignment - For purposes of this agreement, accepting assignment of the Medicare Part B payment means requesting direct Part B payment from the Medicare program. Under an assignment, the approved charge, determined by the Medicare carrier, shall be the full charge for the service covered under Part B. The participant shall not collect from the beneficiary or other person or organization for covered services more than the applicable deductible and coinsurance.”
When enrolling in Medicare as a participating provider or DME supplier, you are agreeing to accept assignment on your claims. Non-participating providers and suppliers can choose on a claim by claim basis to select yes or no for accept assignment.
There is also a box on the claim form (box 13, found in the middle on the right hand side) for “Insured’s or authorized person’s signature” to “authorize payment of medical benefits to the undersigned physician or supplier for services described below” (below meaning the services on the claim form being billed out).
Medicare’s instructions state:
“Item 12 – The patient's signature authorizes release of medical information necessary to process the claim. It also authorizes payments of benefits to the provider of service or supplier when the provider of service or supplier accepts assignment on the claim.”
“Item 13 - The patient’s signature or the statement “signature on file” in this item authorizes payment of medical benefits to the physician or supplier. The patient or his/her authorized representative signs this item or the signature must be on file separately with the provider as an authorization. However, note that when payment under the Act can only be made on an assignment-related basis or when payment is for services furnished by a participating physician or supplier, a patient’s signature or a “signature on file” is not required in order for Medicare payment to be made directly to the physician or supplier.”
But do the same rules apply outside of Medicare? Here is a link to a great article that discusses the guidelines and confusion surrounding this topic:
https://www.instacode.com/article/what-does-accept-assignment-mean
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