A Medicare beneficiary receives covered services from a nonparticipating physician who chooses not to accept assignment for the claim. Which statement describes the financial consequence?

Why B is correct

A nonparticipating physician has not signed the agreement to accept assignment on all Medicare claims. When such a physician does not take assignment, the physician may balance-bill the beneficiary for the difference between the actual charge and the Medicare-approved amount, but only up to a statutory limiting charge set above the approved amount. This contrasts with a participating provider, who accepts the approved amount as payment in full on every claim, and it means the beneficiary's out-of-pocket cost is higher but still capped by law.

Why the other options are wrong

• A) Accepting the approved amount as full payment is the obligation of a participating provider who takes assignment; a nonparticipating physician who declines assignment is not bound by it.
• C) The physician's charge is capped by the Medicare limiting charge, so balance billing above the approved amount is permitted only within the statutory ceiling, not without limit.
• D) Medicare still pays its share of the approved amount; the beneficiary simply faces higher cost-sharing and balance billing, not a loss of Medicare coverage.

Memory hook

Assignment = accept the approved amount, file with Medicare, done.