A Medicare beneficiary receives Part B services from a provider who accepts assignment. What does accepting assignment mean for the beneficiary?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
When a provider accepts assignment, the provider agrees to accept Medicare's approved amount as payment in full for the service. The beneficiary is responsible only for the annual Part B deductible and the 20% coinsurance; the provider may not bill for the difference between the approved amount and the provider's usual charge. Providers who do not accept assignment (non-participating) may bill up to 15% above the approved amount under the limiting charge rule. Assignment vs. non-assignment is a claims-payment concept tested under AH-III.D.1h, and Medicare generally pays the provider directly rather than the beneficiary.
Why the other options are wrong
- B) Balance billing above the approved amount applies to non-assignment situations, subject to the 15% limiting charge; an assigning provider accepts the approved amount in full.
- C) Medicare typically pays the participating provider directly; assignment concerns the amount the provider accepts, not who receives the payment.
- D) The beneficiary is not free to set the amount; the approved amount, deductible, and coinsurance are fixed by Medicare rules.
Memory hook
Accepts assignment = takes Medicare's price, bills you only your 20%. No surprise balance bills.