What must a nonparticipating physician do to ensure they receive the correct reimbursement from Medicare?

What must a nonparticipating physician do to ensure they receive the correct reimbursement from Medicare?

• A. Charge the full standard fee
• B. Accept assignment on the claim
• C. Bill the patient the full amount
• D. Use the participating provider fee schedule

Answer: (B)

To ensure the correct reimbursement from Medicare, a nonparticipating physician must accept assignment on the claim. Accepting assignment means that the physician agrees to accept the Medicare-approved amount for their services as full payment. By doing this, the physician can ensure that they will receive direct reimbursement from Medicare, rather than waiting for the patient to potentially pay the full charge and then seek reimbursement themselves. When a nonparticipating physician accepts assignment, they are also responsible for collecting the applicable coinsurance and deductibles from the patient, which encourages the patient to seek necessary care without financial barriers based on unexpected charges. Moreover, accepting assignment can help improve the physician's cash flow since Medicare reimburses them directly. The other options do not adequately ensure proper reimbursement from Medicare. Charging the full standard fee or billing the patient the full amount could lead to confusion regarding payment responsibilities and may not align with Medicare's guidelines. Using the participating provider fee schedule is relevant for participating physicians, but it does not apply in the same way for nonparticipating ones unless they accept assignment. Therefore, accepting assignment on the claim is the correct procedure for facilitating Medicare reimbursement effectively.

To ensure the correct reimbursement from Medicare, a nonparticipating physician must accept assignment on the claim. Accepting assignment means that the physician agrees to accept the Medicare-approved amount for their services as full payment. By doing this, the physician can ensure that they will receive direct reimbursement from Medicare, rather than waiting for the patient to potentially pay the full charge and then seek reimbursement themselves.

When a nonparticipating physician accepts assignment, they are also responsible for collecting the applicable coinsurance and deductibles from the patient, which encourages the patient to seek necessary care without financial barriers based on unexpected charges. Moreover, accepting assignment can help improve the physician's cash flow since Medicare reimburses them directly.

The other options do not adequately ensure proper reimbursement from Medicare. Charging the full standard fee or billing the patient the full amount could lead to confusion regarding payment responsibilities and may not align with Medicare's guidelines. Using the participating provider fee schedule is relevant for participating physicians, but it does not apply in the same way for nonparticipating ones unless they accept assignment. Therefore, accepting assignment on the claim is the correct procedure for facilitating Medicare reimbursement effectively.