In cases where a physician does not accept assignment, how is the patient's financial liability calculated?

In cases where a physician does not accept assignment, how is the patient's financial liability calculated?

• A. Based on full charges only
• B. Only by the non-PAR Fee Schedule amount
• C. By balancing total charges and limitations
• D. Only depending on Medicare's payments

Answer: (C)

When a physician does not accept assignment, the patient's financial liability is calculated by balancing total charges and limitations. This approach takes into account the physician's full charges for the services rendered while also considering the maximum allowable amount that Medicare will reimburse for those services. In such cases, the physician may bill the patient for the difference between the total charge and what Medicare pays, subject to the limitations set by Medicare. Therefore, the financial responsibility for the patient often includes any excess charges that exceed the Medicare allowable amount, which leads to a clearer financial understanding of what the patient must pay out of pocket. This method provides a structured way to determine financial responsibility, ensuring that patients are aware of both the provider's charges and the amount covered by their insurance. Other methods mentioned would not accurately reflect the balance between the physician's charges and their acceptance of Medicare's payment limits; thus, they do not represent correct calculations of the patient's liability when assignment is not accepted.

When a physician does not accept assignment, the patient's financial liability is calculated by balancing total charges and limitations. This approach takes into account the physician's full charges for the services rendered while also considering the maximum allowable amount that Medicare will reimburse for those services.

In such cases, the physician may bill the patient for the difference between the total charge and what Medicare pays, subject to the limitations set by Medicare. Therefore, the financial responsibility for the patient often includes any excess charges that exceed the Medicare allowable amount, which leads to a clearer financial understanding of what the patient must pay out of pocket. This method provides a structured way to determine financial responsibility, ensuring that patients are aware of both the provider's charges and the amount covered by their insurance.

Other methods mentioned would not accurately reflect the balance between the physician's charges and their acceptance of Medicare's payment limits; thus, they do not represent correct calculations of the patient's liability when assignment is not accepted.