Billing Non-Assigned Part 2

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A few weeks ago, Essentially Women posted a blog about billing non-assigned, written by Jeff Baird, JD, from Brown & Fortunato, PC. Jeff recently posted a follow-up to his original article, with additional information. 

For the last four decades, DME suppliers have primarily provided DME on an assigned basis. Medicare paid the suppliers directly and the patients only had to pay their copayments and deductibles. Until approximately 2010, this worked out for DME suppliers. Reimbursement was high enough and audits were not onerous—meaning that the “assignment model” worked relatively well.

With competitive bidding and lower reimbursement, it's challenging for suppliers to rely entirely on an assignment model. More and more suppliers are electing to be non-participating and billing non-assigned. If a non-participating supplier provides a product on a non-assigned basis, this means that the supplier (i) is not agreeing to accept the Medicare allowable as payment in full, (ii) can collect directly from the patient, and (iii) can charge more than the Medicare allowable in such cases. The supplier must file the claim with Medicare on behalf of the patient and any Medicare reimbursement will go directly to the patient.

Read the full article from Medtrade.


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