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all right how's it going guys Tony Merritt Otto here welcome to the Medicare billing group for PT ot and SLPs I want to talk to you today about assignment of benefits whether you're gonna accept assignment or not accept assignment I recently published a video regarding being a par participating provider or non par non participating provider now we want to talk about accepting assignment because this is one of those topics that trips a lot of people up so let's jump into the screen and we're just gonna start this is from the nuridium website and this is their description of assignment and non assignment of benefits now I hate to read to you guys I know you guys can read but there are a couple key components in here that I think we just need to get through so obviously under the Medicare program there's two reimbursement options either you accept assignment or you don't ex assignment of benefits applies to all participating providers so if you fill out the CMS 460 and choose to be a participating provider you must accept the assignment you do not have the option to not accept assignment if the provider accepts assignment Medicare will make payment directly to the provider under this method the provider agrees to accept the Medicare approved amount as payment in full now if you saw my last video about being pardoned on par you understand that when they say the approved amount that is the Medicare allowed amount if you don't know what that is you go to look up the CMS physician fee schedule plug in your specific CPT codes the one you use most frequently and look up the allowed amount for your state now there are certain guidelines whether your app are non par non par is going to be reimbursed at 95% of the allowed amount and then you may build the patient the addition up to the maximum limiting charge but as a par provider Urich's you accepting the commitment to accept the full allowed amount of the Medicare fee schedule Medicare pays 80% of the allowed amount and then either the supplemental Medigap plan or a secondary plan or the patient themselves will pay the remaining 20% on item 27 on the CMS form you'll indicate yes or no for accepting assignment the only person in this scenario who cannot choose to not accept assignment is a non part of a derp okay you still must be credentialed as non part part providers cannot choose to not accept assignment sorry for the double negatives guys the difference you know here so when accepting assignment the beneficiary may be billed the 20% coinsurance which typically is going to go to the secondary which would be a Medigap supplemental plan or maybe another insurance plan and any unmet deductible for the services not covered by Medicare the difference between the billed amount and the Medicare approved amount cannot be billed some people will call that balance billing but bottom line you're allowed to collect up to the Medicare allowed amount note the 20% coinsurance based on the 20% Medicare approved amount I can't stress this part enough there's a difference between the Medicare approved amount and the maximum allowed amount okay so keep that in mind some private insurance policies may reimburse the beneficiary for services not covered by Medicare unassigned claims the supplier in this case where the supplier is bound by the assignment agreement and basically what's happening is you're getting into an agreement with the beneficiary to say you as a provider power provider or non par accepting assignment will accept the Medicare proved amount as payment in full payment goes to you instead of going to the beneficiary even if no payment is issued as a result of the payment being applied toward the beneficiaries out annual deductible he/she she may still accept Medicare's approved amount as payment in full let's see what else we have here possible it's possible for a supplier to accept assignment on a partially paid bill so like let's say the the beneficiary deductible gets met halfway through the claim right so you would have to charge and collect from the beneficiary the remainder of that deductible that had not been met assuming there wasn't a Medigap supplemental or secondary plan paying yet and then you would accept what was reimbursed as payment in full after that after that remaining balance if Medicare allowed amount is less than the amount of beneficiary already paid the supplier must refund the difference to the beneficiary so again you can't balance bill you can't collect or accept any overpayments if you do collect an overpayment maybe you miss estimate the amount the beneficiary will owe you must refund that and there are certain guidelines and timeframes that you have to get that money back to the beneficiary the supplier can collect charges from the beneficiary for services that are denied has not covered by Medicare even though assignment was accepted and this is where we get into non covered services either a doesn't meet medical necessity or it's a service that Medicare won't reimburse for like dry needling assignment cannot be cancelled once the claim has been processed by the carrier and set a notice of determination to both parties okay so you can't change your mind once you choose it on that claim on that date of service this also applies to all future resubmissions adjustments appeals in the case of a denial around a pain under payment participating physicians and suppliers may not cancel assignment as this would be a violation of the participation agreement let's if a supplier consistently violates the assignment agreement the carrier can impose fines and charges Medicare carrier are carriers are required to report and act on any violations okay supplier is in violation of the assignment agreement if they collect or attempt to collect more than the duck-duck goodness gracious more than the deductible or coinsurance amount or a fee for the paperwork involve them filing a claim you know a lot of people try to charge these little extra fees you just can't do it if your pardon on par you have to play by the rules physician suppliers contracting with billing agents are ultimately responsible for the activities of those agents and this goes back to it's not a bad idea to outsource your billing in the right situation but you have to understand the liability because now it's not just you and your actions it's the actions of the contracted billing agent that you're responsible for so please keep that in mind when assignments accepted the billing agent should not build the beneficiary for any amount above the 20% coinsurance or any unmet deductible okay this is where I think it really gets interesting so non assignment of benefits the second reimbursement method choosing to not accept assignment of benefits under this method the non participating provider is the only provider that can file a claim as non assigned okay when the provider does not accept assignment the Medicare payment will be made directly to the beneficiary so if you want to receive the money you have to accept assignment which means you're gonna limit yourself to the Medicare approved amount the provider may bill the beneficiary no more than the limiting charge for covered services so I know we've just gone through nine minutes and 20 seconds of information but this is really the juicy part this is the part that you want to pay attention to you pull up your chair shut off all the other devices and listen to this part carefully if you choose to be non par you can accept assignment or not accept assignment if you accept assignment payment will come to you awesome but you're limiting limited to the allowed amount which is the same as the Medicare allowed amount okay not the limiting chart now if you choose to not accept assignment you're allowed to collect up to the maximum limiting charge but the Medicare payment is going to the beneficiary that means you're gonna absorb the cost the effort the added headache of collecting payment from the patient now you might have an independently wealthy patient you might have a community of patients Medicare beneficiaries who are more than happy to pay you the maximum limiting charge allowed by Medicare but many of us don't and the reality is many Medicare beneficiaries are living on a fixed income they don't have huge disposable incomes that they could just pay a hundred plus dollars per visit whenever you they come to see you so the effort and the the how do I say it I think that you're setting yourself up for more work on the administrative side more cost involved in collecting the money from the beneficiary as opposed to just choosing to be a part provider being participating provider receiving the Medicare payment directly to you having that information auto forward to the Medigap supplemental plan like there are just so many benefits and conveniences that come along with being a participating provider but that being said many of you are choosing not to be participating provider I totally respect your decision I just want you to understand as a non-party if you choose not to accept assignment you may charge up to that limiting amount however the payment has to go to the beneficiary then the beneficiary has to pay you if you choose to be par you must accept the assignment you will receive night what is it a hundred percent of the allowed amount which is five percent higher than the non par provider will receive but the benefit is that payment goes to you directly instead of going to the beneficiary guys I hope this clears up some of the misconceptions that are out there about accepting assignment not accepting the assignment go to the source look at the information for yourself read the guidelines try to work it out because I really do think there's more benefit more upside to being a participating provider who accepts assignment then trying to go the non par to collect a little bit extra but then have the added headache and hassle of trying to track down those beneficiaries to collect your money guys I hope this was helpful if it is let me know in the comments directly on YouTube YouTube comments are super important to growing the channel and they helped me understand what information I need to get to you I'll see you guys in the next video thanks for watching